The medulloblastoma in adults, despite radical resection and radiotherapy can recur after 10-25 years as in this case.

The tumor at the posterior fossa was ignored because it was not causing any shift of the structures, in opposite to the frontal huge mass which causing an impending conning.

This frontal part of the tumor could be a meningioma, because it has matrix and the consistency is looking as meningioma, but spectroscopy of the frontal part was more malignant than the part in the posterior fossa.

It turned to be meningioma with malignant features, but total resection with matrix, achieved the final goal.

Late radionecrosis of the right cerebellar area must be considered in mind.

The patient was operated by me 05-April-1999 for medulloblastoma and was doing fine and underwent radiation 35 Gy 20 fractions whole body and 20 Gy 10 fractions  over 6 weeks. The patient came several times over the years and several MRI of the brain ruled out recurrence. The patient then came 19-August-2014 with MRI of the brain showing small mass in the right frontal lobe. The patient then was sent for investigations, but she disappeared and came 10-September-2018 with numbness left upper limb and both lower limbs for 1 year with fainting attacks. The decreased hearing right side before the first surgery. The patient was sent for investigation. MRI brain done 10-September-2018 showing huge mass in the right frontal area shifting the midline structures to the left.  The patient was advised to undergo surgery, but she disappeared.

The husband by telephone, telling that she is deteriorating for what she was admitted to Shmaisani hospital 28-March-2021. The patient is bedridden walking with help of 2 persons with difficulty, hallucinating at times and with difficult verbal communication and she could remember me as her doctor. Left sided hemihypalgesia and paresis.

The patient was sent for investigations and MRI repeated 29-March-2021 under G.A. showing considerable enlargement of the mass in the right frontal area 6X6 cm in dimensions, pushing down the brain stem, including the red nucleus. There is appearance of recurrence at the previous surgery in the posterior fossa but not causing compression, not violating the 4th ventricle, but reaching the upper vermis up the edge of tentorium. Spectroscopy showed high cholesterine level of the frontal part, alarming malignant nature of this part. The mass in the right cerebellar hemisphere is less malignant with normal cholesterine level. Due to preoperative medication, after one day, the function of the reticular activating formation improved and the patient became more conscious to show full blown frontal lobe syndrome with aggressiveness, for what preoperative interrogation with the patient will be impossible. Consent for surgery was obtained from her husband from Saudia by telephone, due to Covid restrictions.

Right frontal osteoplastic craniotomy with reflection of the flap to the right ear. The dura was suck to the bone, that it was torn during opening. The tumor was seen, as be having matrix to the dura at its medial aspect. It was highly vascular, reddish resembling a meningioma. Using SONOCA 300 ultrasonic aspirator and other facilities, piece meal resection of the tumor was achieved. It was multiple consistency, with rich vascularity. The solid parts were impossible to remove by SONOCA 300.It was removed by pituitaries after coagulation. The tumor margins were followed until all its parts were removed. Several parts of the tumor were sent for histological verification. It was possible to see the right olfactory tract running anterior and inferior.  The falx cerebri was at its medial border with pericallosal arteries running above the corpus callosum. Some tiny structures were preserved to avoid spillage of CSF from the ventricles to prevent contamination of the tumor to the ventricular system. The bed of the tumor was covered with three pieces of  Surgicele to control bleeding. The matrix of the tumor was coagulated and the dural defect (which actually the matrix of the tumor) was closed using part of the muscle of the reflected flap to achieve water-tight closure. Routine closure of the wound. Before extubation, the patient was sent to MRI and 2W axial MRI confirmed total resection of the tumor.

Smooth postoperative recovery. The power of the left side of the body improved. She was sent to the ICU for 20 hours observation.

The final histologic result was meningioma WHO Grade II. (Prof. Yahia F. Dajani, M. B. Ch. B. (Bristol), F. R. C. Path. ( London) Consultant Pathologist 01/04/2021).

The patient started to show some regression of the frontal lobe syndrome and can walk in the corridor with clean wound.

After decreasing the Decadron dose, the patient's frontal lobe syndrome became more prominent and check CT-scan of the brain done 03-April-2021 was uneventful.