Erdogan Onur, Eröksüz Melih, Şahin Yener, Gedik Buket, Sakar Mustafa, Dağçınar Adnan
Department of Neurosurgery, School of Medicine, Marmara University, Istanbul, Turkey.
Institute of Neurological Sciences, Marmara University, Istanbul, Turkey.
Childs Nerv Syst. 2025 May 16;41(1):181. doi: 10.1007/s00381-025-06849-7.
Medulloblastoma is the most common malignant brain tumor in children, known for its high propensity to disseminate through the cerebrospinal fluid (CSF), particularly within the subarachnoid space. Leptomeningeal seeding, where tumor cells attach and proliferate within the leptomeninges, is a common manifestation. However, epidural seeding is an exceptionally rare occurrence, with very few cases documented in the literature. We present the case of an 8-year-old male diagnosed with anaplastic large cell medulloblastoma, who underwent complete tumor resection followed by radiotherapy and chemotherapy. Four years postoperatively, routine imaging revealed multiple thoracic spinal seedings and an epidural lesion at the S2-3 level. Surgical intervention confirmed the mass was confined to the epidural space, without intradural involvement, a notable finding given the rarity of this presentation. The mechanism behind epidural seeding remains unclear, though it was hypothesized that tumor cells may have been introduced during a lumbar puncture performed in the post-diagnosis period. This case contributes to the limited body of literature on epidural seeding in medulloblastoma, highlighting the importance of considering this rare phenomenon in long-term follow-up and surveillance of patients.
髓母细胞瘤是儿童最常见的恶性脑肿瘤，以其易于通过脑脊液（CSF）播散，尤其是在蛛网膜下腔内播散而闻名。肿瘤细胞在软脑膜内附着和增殖的软脑膜播散是一种常见表现。然而，硬膜外播散极为罕见，文献中记载的病例极少。我们报告一例8岁男性诊断为间变性大细胞髓母细胞瘤，该患者接受了肿瘤全切术，随后进行放疗和化疗。术后四年，常规影像学检查发现多个胸椎播散灶以及S2 - 3水平的硬膜外病变。手术干预证实肿块局限于硬膜外间隙，无硬膜内受累，鉴于这种表现罕见，这是一个值得注意的发现。硬膜外播散的机制尚不清楚，不过据推测肿瘤细胞可能是在确诊后进行腰椎穿刺时进入的。该病例丰富了关于髓母细胞瘤硬膜外播散的有限文献，强调了在患者长期随访和监测中考虑这种罕见现象的重要性。
