{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T14:22:36Z","timestamp":1783174956934,"version":"3.54.6"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Medulloblastoma can cause extraneural metastasis, particularly to the bones. However, only a few reports have shown that hypercalcemia occurs with medulloblastoma, and there are no reports on hypercalcemia causing consciousness disturbance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 17-year-old male patient was treated for medulloblastoma with spinal and intracranial metastasis. He underwent subtotal resection, followed by radiotherapy to the craniospinal axis, posterior fossa, and primary site, as well as high-dose chemotherapy with autologous hematopoietic stem cell transplantation. He achieved complete remission after the initial treatment. However, 30 months after tumor resection, he developed headache, nausea, fatigue, and pain in the limbs and back, followed by consciousness disturbance. He had severe hypercalcemia (17.7 mg\/dL) and multiple bone metastases. His symptoms improved with hypercalcemia treatment, and salvage chemotherapy resulted in complete remission of the recurrent disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Previous studies have not reported consciousness disturbance caused by hypercalcemia due to medulloblastoma bone metastasis. Hypercalcemia causes various symptoms, affecting the neurological, cardiac, and gastrointestinal systems. Some of its symptoms, such as fatigue, nausea, vomiting, and bradycardia, are similar to those of increased intracranial pressure. Therefore, hypercalcemia attributed to bone metastases should be considered in the differential diagnosis of consciousness disturbance during the course of medulloblastoma.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25318\">https:\/\/thejns.org\/doi\/10.3171\/CASE25318<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25318","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:12:00Z","timestamp":1769685120000},"source":"Crossref","is-referenced-by-count":1,"title":["Hypercalcemia associated with relapsed medulloblastoma due to bone metastasis: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Rikuto","family":"Ito","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Kanamori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiteru","family":"Shimoda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-6244","authenticated-orcid":true,"given":"Masahiro","family":"Irie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3161-8968","authenticated-orcid":true,"given":"Hidetaka","family":"Niizuma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0253-7122","authenticated-orcid":true,"given":"Hirofumi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tohoku University Hospital, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tohoku University Hospital, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1894-1824","authenticated-orcid":true,"given":"Yonehiro","family":"Kanemura","sequence":"additional","affiliation":[{"name":"Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka"},{"name":"Department of Neurosurgery, NHO Osaka National Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-8739","authenticated-orcid":true,"given":"Atsuo","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Eur J Cancer","first-page":"36","article-title":"Incidence and survival of children and young people with central nervous system embryonal tumours in the North of England, 1990-2013","volume":"61","author":"Fairley","year":"2016","unstructured":"Fairley LPicton SVMcNally RJBailey SMcCabe MGFeltbower RG.Incidence and survival of children and young people with central nervous system embryonal tumours in the North of England, 1990-2013. Eur J Cancer. 2016;61:36-43."},{"issue":"10","key":"bib2","series-title":"Lancet Oncol","first-page":"813","article-title":"Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial","volume":"7","author":"Gajjar","year":"2006","unstructured":"Gajjar AChintagumpala MAshley DRisk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol. 2006;7(10):813-820."},{"issue":"7","key":"bib3","series-title":"Neuro Oncol","first-page":"1166","article-title":"Revised clinical and molecular risk strata define the incidence and pattern of failure in medulloblastoma following risk-adapted radiotherapy and dose-intensive chemotherapy: results from a phase III multi-institutional study","volume":"24","author":"Lucas","year":"2022","unstructured":"Lucas JTTinkle CLHuang JRevised clinical and molecular risk strata define the incidence and pattern of failure in medulloblastoma following risk-adapted radiotherapy and dose-intensive chemotherapy: results from a phase III multi-institutional study. Neuro Oncol. 2022;24(7):1166-1175."},{"issue":"2","key":"bib4","series-title":"Int J Radiat Oncol Biol Phys","first-page":"269","article-title":"Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT \u201991","volume":"46","author":"Kortmann","year":"2000","unstructured":"Kortmann RDK\u00fchl JTimmermann BPostoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT \u201991. Int J Radiat Oncol Biol Phys. 2000;46(2):269-279."},{"issue":"5","key":"bib5","series-title":"Eur J Cancer","first-page":"727","article-title":"Outcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP\/UKCCSG PNET-3 chemotherapy","volume":"41","author":"Taylor","year":"2005","unstructured":"Taylor REBailey CCRobinson KJOutcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP\/UKCCSG PNET-3 chemotherapy. Eur J Cancer. 2005;41(5):727-734."},{"issue":"7","key":"bib6","series-title":"Cancer","first-page":"1600","article-title":"The change in patterns of relapse in medulloblastoma","volume":"68","author":"Tarbell","year":"1991","unstructured":"Tarbell NJLoeffler JSSilver BThe change in patterns of relapse in medulloblastoma. Cancer. 1991;68(7):1600-1604."},{"issue":"2","key":"bib7","series-title":"J Neurooncol","first-page":"187","article-title":"Extraneural metastasis in intracranial tumors in children: the experience of a single center","volume":"79","author":"Varan","year":"2006","unstructured":"Varan ASari NAkalan NExtraneural metastasis in intracranial tumors in children: the experience of a single center. J Neurooncol. 2006;79(2):187-190."},{"issue":"4","key":"bib8","series-title":"Acta Neuropathol","first-page":"309","article-title":"Extraneural metastases of paediatric brain tumours","volume":"105","author":"Rickert","year":"2003","unstructured":"Rickert CH.Extraneural metastases of paediatric brain tumours. Acta Neuropathol. 2003;105(4):309-327."},{"issue":"12","key":"bib9","series-title":"Cells","first-page":"1051","article-title":"Hypercalcemia in cancer: causes, effects, and treatment strategies","volume":"13","author":"Bartkiewicz","year":"2024","unstructured":"Bartkiewicz PKunachowicz DFilipski MStebel ALigoda JRembia\u0142kowska N.Hypercalcemia in cancer: causes, effects, and treatment strategies. Cells. 2024;13(12):1051."},{"issue":"4","key":"bib10","series-title":"Neuro Endocrinol Lett","first-page":"547","article-title":"Hypercalcemia in glioblastoma multiforme","volume":"27","author":"Seif","year":"2006","unstructured":"Seif FEAzar SBarake MSawaya R.Hypercalcemia in glioblastoma multiforme. Neuro Endocrinol Lett. 2006;27(4):547-548."},{"issue":"2","key":"bib11","series-title":"Med Pediatr Oncol","first-page":"126","article-title":"Brief report: medulloblastoma with widespread skeletal metastases presenting with hypercalcemia","volume":"33","author":"Aky\u00fcz","year":"1999","unstructured":"Aky\u00fcz CYal\u00e7in BKutluk TCila AB\u00fcy\u00fckpamuk\u00e7u M.Brief report: medulloblastoma with widespread skeletal metastases presenting with hypercalcemia. Med Pediatr Oncol. 1999;33(2):126-128."},{"issue":"4","key":"bib12","series-title":"Eur J Pediatr","first-page":"434","article-title":"Hypercalcaemia in cerebellar medulloblastoma: pathogenesis of solid tumour-associated hypercalcaemia","volume":"146","author":"Arisaka","year":"1987","unstructured":"Arisaka OObinata KYabuta KIshimoto KSato K.Hypercalcaemia in cerebellar medulloblastoma: pathogenesis of solid tumour-associated hypercalcaemia. Eur J Pediatr. 1987;146(4):434-436."},{"issue":"6","key":"bib13","series-title":"Horm Res","first-page":"268","article-title":"Hypercalcaemia in relapsed medulloblastoma 8 years post-diagnosis; evidence to support PTHrP production by medulloblastoma cells","volume":"66","author":"Dharmaraj","year":"2006","unstructured":"Dharmaraj PBall SJohnstone HHypercalcaemia in relapsed medulloblastoma 8 years post-diagnosis; evidence to support PTHrP production by medulloblastoma cells. Horm Res. 2006;66(6):268-272."},{"issue":"3","key":"bib14","series-title":"Clin Neurol Neurosurg","first-page":"323","article-title":"Skeletal spread of an anaplastic astrocytoma (WHO grade III) and preservation of histopathological properties within metastases","volume":"115","author":"Martens","year":"2013","unstructured":"Martens TMatschke JM\u00fcller CSkeletal spread of an anaplastic astrocytoma (WHO grade III) and preservation of histopathological properties within metastases. Clin Neurol Neurosurg. 2013;115(3):323-328."},{"issue":"6","key":"bib15","series-title":"Tumori","first-page":"808","article-title":"Bone marrow metastases from anaplastic oligodendroglioma presenting with pancytopenia and hypogammaglobulinemia: a case report","volume":"97","author":"Cordiano","year":"2011","unstructured":"Cordiano VMiserocchi FStorti M.Bone marrow metastases from anaplastic oligodendroglioma presenting with pancytopenia and hypogammaglobulinemia: a case report. Tumori. 2011;97(6):808-811."},{"issue":"4","key":"bib16","series-title":"Med Pediatr Oncol","first-page":"295","article-title":"Cytogenetic abnormalities in a disseminated medulloblastoma","volume":"21","author":"Stuart","year":"1993","unstructured":"Stuart AGPearson ADEmslie JCytogenetic abnormalities in a disseminated medulloblastoma. Med Pediatr Oncol. 1993;21(4):295-298."},{"issue":"1","key":"bib17","series-title":"Endocr Pract","first-page":"67","article-title":"Congenital craniopharyngioma and hypercalcemia induced by parathyroid hormone-related protein","volume":"13","author":"Brown","year":"2007","unstructured":"Brown JLBurton DWDeftos LJSmith AAPincus DWHaller MJ.Congenital craniopharyngioma and hypercalcemia induced by parathyroid hormone-related protein. Endocr Pract. 2007;13(1):67-71."},{"issue":"6","key":"bib18","series-title":"Intern Med","first-page":"486","article-title":"Hypercalcemia accompanied by hypothalamic hypopituitarism, central diabetes inspidus and hyperthyroidism","volume":"38","author":"Wada","year":"1999","unstructured":"Wada SKurihara SImamaki KHypercalcemia accompanied by hypothalamic hypopituitarism, central diabetes inspidus and hyperthyroidism. Intern Med. 1999;38(6):486-490."},{"key":"bib19","series-title":"J Neurosurg","first-page":"186","article-title":"Extracranial metastases of a glioblastoma multiforme","volume":"19","author":"Wisiol","year":"1962","unstructured":"Wisiol ESHandler SFrench LA.Extracranial metastases of a glioblastoma multiforme. J Neurosurg. 1962;19:186-194."},{"key":"bib20","series-title":"WHO Classification of Tumours:","author":"The WHO Classification of Tumours Editorial Board","year":"2021","unstructured":"The WHO Classification of Tumours Editorial Board.WHO Classification of Tumours: Central Nervous System Tumours. 5th ed. IARC; 2021."},{"issue":"4","key":"bib21","series-title":"Acta Neuropathol","first-page":"615","article-title":"Rapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples","volume":"123","author":"Northcott","year":"2012","unstructured":"Northcott PAShih DJRemke MRapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples. Acta Neuropathol. 2012;123(4):615-626."},{"issue":"9","key":"bib22","series-title":"Neuro Oncol","first-page":"1236","article-title":"Phase II study of irinotecan in combination with temozolomide (TEMIRI) in children with recurrent or refractory medulloblastoma: a joint ITCC and SIOPE brain tumor study","volume":"15","author":"Grill","year":"2013","unstructured":"Grill JGeoerger BGesner LPhase II study of irinotecan in combination with temozolomide (TEMIRI) in children with recurrent or refractory medulloblastoma: a joint ITCC and SIOPE brain tumor study. Neuro Oncol. 2013;15(9):1236-1243."},{"issue":"3","key":"bib23","series-title":"J Neurooncol","first-page":"515","article-title":"Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study","volume":"129","author":"Sabel","year":"2016","unstructured":"Sabel MFleischhack GTippelt SRelapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol. 2016;129(3):515-524."},{"issue":"12","key":"bib24","series-title":"Lancet Child Adolesc Health","first-page":"865","article-title":"Time, pattern, and outcome of medulloblastoma relapse and their association with tumour biology at diagnosis and therapy: a multicentre cohort study","volume":"4","author":"Hill","year":"2020","unstructured":"Hill RMRichardson SSchwalbe ECTime, pattern, and outcome of medulloblastoma relapse and their association with tumour biology at diagnosis and therapy: a multicentre cohort study. Lancet Child Adolesc Health. 2020;4(12):865-874."},{"issue":"1","key":"bib25","series-title":"J Neurol Neurosurg Psychiatry","first-page":"80","article-title":"Extracranial metastases of medulloblastoma in adults: literature review","volume":"54","author":"Rochkind","year":"1991","unstructured":"Rochkind SBlatt ISadeh MGoldhammer Y.Extracranial metastases of medulloblastoma in adults: literature review. J Neurol Neurosurg Psychiatry. 1991;54(1):80-86."},{"issue":"1","key":"bib26","series-title":"Int J Radiat Oncol Biol Phys","first-page":"72","article-title":"Prognostic factors after extraneural metastasis of medulloblastoma","volume":"78","author":"Mazloom","year":"2010","unstructured":"Mazloom AZangeneh AHPaulino AC.Prognostic factors after extraneural metastasis of medulloblastoma. Int J Radiat Oncol Biol Phys. 2010;78(1):72-78."},{"issue":"4","key":"bib27","series-title":"Asian J Neurosurg","first-page":"331","article-title":"A case of early extraneural medulloblastoma metastases in a young adult","volume":"10","author":"Kondoff","year":"2015","unstructured":"Kondoff SIMilev MDLaleva LNA case of early extraneural medulloblastoma metastases in a young adult. Asian J Neurosurg. 2015;10(4):331-333."},{"issue":"4","key":"bib28","series-title":"Oncol Lett","first-page":"2295","article-title":"Medulloblastoma with soft-tissue and skeletal metastases in an adult: a case report","volume":"10","author":"Geng","year":"2015","unstructured":"Geng DSong XLiu JYu ZNing F.Medulloblastoma with soft-tissue and skeletal metastases in an adult: a case report. Oncol Lett. 2015;10(4):2295-2298."},{"issue":"5","key":"bib29","series-title":"Clin Nucl Med","first-page":"354","article-title":"Extraneural metastases from desmoplastic medulloblastoma masquerading as lymphoma","volume":"42","author":"Mahajan","year":"2017","unstructured":"Mahajan APaul PSridhar EExtraneural metastases from desmoplastic medulloblastoma masquerading as lymphoma. Clin Nucl Med. 2017;42(5):354-357."},{"issue":"11","key":"bib30","series-title":"Oncotarget","first-page":"10175","article-title":"Recurrent extraneural sonic hedgehog medulloblastoma exhibiting sustained response to vismodegib and temozolomide monotherapies and inter-metastatic molecular heterogeneity at progression","volume":"9","author":"Petrirena","year":"2018","unstructured":"Petrirena GJMasliah-Planchon JSala QRecurrent extraneural sonic hedgehog medulloblastoma exhibiting sustained response to vismodegib and temozolomide monotherapies and inter-metastatic molecular heterogeneity at progression. Oncotarget. 2018;9(11):10175-10183."},{"issue":"1","key":"bib31","series-title":"Pediatr Neurosurg","first-page":"71","article-title":"Cervical extraneural lymph node metastasis in a patient with medulloblastoma","volume":"54","author":"Ata\u015f","year":"2019","unstructured":"Ata\u015f EVaran AAky\u00fcz CAkalan NB\u00fcy\u00fckpamuk\u00e7u M.Cervical extraneural lymph node metastasis in a patient with medulloblastoma. Pediatr Neurosurg. 2019;54(1):71-73."},{"issue":"2","key":"bib32","series-title":"J Pediatr Hematol Oncol","first-page":"e593","article-title":"Isolated bone recurrence of medulloblastoma with MYCN amplification and TP53 loss: a case report","volume":"44","author":"Takahashi","year":"2022","unstructured":"Takahashi YKudo KOgawa KIsolated bone recurrence of medulloblastoma with MYCN amplification and TP53 loss: a case report. J Pediatr Hematol Oncol. 2022;44(2):e593-e596."},{"issue":"2","key":"bib33","series-title":"Cureus","first-page":"e34732","article-title":"Recurrent extraneural metastatic medulloblastoma in an adult presenting with a superscan and treated with radium-223","volume":"15","author":"Mou","year":"2023","unstructured":"Mou BCruz-Lim EM.Recurrent extraneural metastatic medulloblastoma in an adult presenting with a superscan and treated with radium-223. Cureus. 2023;15(2):e34732."},{"issue":"5","key":"bib34","series-title":"Cureus","first-page":"e61339","article-title":"Cervical lymph node metastasis from medulloblastoma in a young adult: case report and literature review","volume":"16","author":"Harrak","year":"2024","unstructured":"Harrak MKamal SZerbani HCervical lymph node metastasis from medulloblastoma in a young adult: case report and literature review. Cureus. 2024;16(5):e61339."},{"issue":"2","key":"bib35","series-title":"J Neurooncol","first-page":"419","article-title":"Extraneuraxial metastases in medulloblastoma: is histology and molecular biology important?","volume":"135","author":"Gupta","year":"2017","unstructured":"Gupta TDasgupta AEpari SShirsat NChinnaswamy GJalali R.Extraneuraxial metastases in medulloblastoma: is histology and molecular biology important? J Neurooncol. 2017;135(2):419-421."},{"issue":"10","key":"bib36","series-title":"Am J Clin Oncol","first-page":"1015","article-title":"Patterns of failure in patients with adult medulloblastoma presenting without extraneural metastasis","volume":"41","author":"Mokhtech","year":"2018","unstructured":"Mokhtech MMorris CGIndelicato DJRutenberg MSAmdur RJ.Patterns of failure in patients with adult medulloblastoma presenting without extraneural metastasis. Am J Clin Oncol. 2018;41(10):1015-1018."},{"issue":"2","key":"bib37","series-title":"J Investig Med High Impact Case Rep","first-page":"2324709614532798","article-title":"Medulloblastoma in an adult with late extraneural metastases to the mediastinum","volume":"2","author":"Ghose","year":"2014","unstructured":"Ghose AMorris JCBreneman JCEssell JWang JBenzaquen S.Medulloblastoma in an adult with late extraneural metastases to the mediastinum. J Investig Med High Impact Case Rep. 2014;2(2):2324709614532798."},{"issue":"3","key":"bib38","series-title":"Neurosurgery","first-page":"623","article-title":"Adult medulloblastoma: prognostic factors and patterns of relapse","volume":"47","author":"Chan","year":"2000","unstructured":"Chan AWTarbell NJBlack PMAdult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery. 2000;47(3):623-632."},{"issue":"4","key":"bib39","series-title":"Pediatr Blood Cancer","first-page":"611","article-title":"Extraneural metastases of medulloblastoma: desmoplastic variants may have prolonged survival","volume":"62","author":"Young","year":"2015","unstructured":"Young RJKhakoo YYhu SExtraneural metastases of medulloblastoma: desmoplastic variants may have prolonged survival. Pediatr Blood Cancer. 2015;62(4):611-615."},{"issue":"2","key":"bib40","series-title":"J Pediatr Neurosci","first-page":"168","article-title":"Subcutaneous metastasis in medulloblastoma: a case report and review of literature","volume":"8","author":"Maiti","year":"2013","unstructured":"Maiti TSabharwal PPandey PDevi BI.Subcutaneous metastasis in medulloblastoma: a case report and review of literature. J Pediatr Neurosci. 2013;8(2):168-170."},{"issue":"1","key":"bib41","series-title":"Acta Neurol Belg","first-page":"247","article-title":"From cerebellum to skeleton: a case report of SHH-activated medulloblastoma with extraneural spread","volume":"125","author":"Marzouki","year":"2025","unstructured":"Marzouki SDe Vulder NDekeyzer S.From cerebellum to skeleton: a case report of SHH-activated medulloblastoma with extraneural spread. Acta Neurol Belg. 2025;125(1):247-252."},{"issue":"6","key":"bib42","series-title":"J Clin Invest","first-page":"1803","article-title":"Parathyroid hormonelike protein from human renal carcinoma cells. Structural and functional homology with parathyroid hormone","volume":"80","author":"Strewler","year":"1987","unstructured":"Strewler GJStern PHJacobs JWParathyroid hormonelike protein from human renal carcinoma cells. Structural and functional homology with parathyroid hormone. J Clin Invest. 1987;80(6):1803-1807."},{"key":"bib43","series-title":"Clin Neurol Neurosurg","first-page":"239","article-title":"A systematic review of shunt-related extraneural metastases of primary central nervous system tumors","volume":"174","author":"Xu","year":"2018","unstructured":"Xu KKhine KTOoi YCQuinsey CS.A systematic review of shunt-related extraneural metastases of primary central nervous system tumors. Clin Neurol Neurosurg. 2018;174:239-243."},{"issue":"23","key":"bib44","series-title":"J Clin Oncol","first-page":"2936","article-title":"High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)","volume":"31","author":"Tarbell","year":"2013","unstructured":"TarbellNJFriedman HPolkinghorn WRet al.High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031). J Clin Oncol. 2013;31(23):2936-2941."},{"issue":"1","key":"bib45","series-title":"BMC Med Genet","first-page":"10","article-title":"A case of molecularly profiled extraneural medulloblastoma metastases in a child","volume":"19","author":"Mobark","year":"2018","unstructured":"Mobark NAAl-Harbi MMosleh OSantagata SSnuderl MAbedalthagafi M.A case of molecularly profiled extraneural medulloblastoma metastases in a child. BMC Med Genet. 2018;19(1):10."},{"key":"bib1","series-title":"Eur J Cancer","first-page":"36","article-title":"Incidence and survival of children and young people with central nervous system embryonal tumours in the North of England, 1990-2013","volume":"61","author":"Fairley","year":"2016","unstructured":"Fairley LPicton SVMcNally RJBailey SMcCabe MGFeltbower RG.Incidence and survival of children and young people with central nervous system embryonal tumours in the North of England, 1990-2013. Eur J Cancer. 2016;61:36-43."},{"issue":"10","key":"bib2","series-title":"Lancet Oncol","first-page":"813","article-title":"Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial","volume":"7","author":"Gajjar","year":"2006","unstructured":"Gajjar AChintagumpala MAshley DRisk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol. 2006;7(10):813-820."},{"issue":"7","key":"bib3","series-title":"Neuro Oncol","first-page":"1166","article-title":"Revised clinical and molecular risk strata define the incidence and pattern of failure in medulloblastoma following risk-adapted radiotherapy and dose-intensive chemotherapy: results from a phase III multi-institutional study","volume":"24","author":"Lucas","year":"2022","unstructured":"Lucas JTTinkle CLHuang JRevised clinical and molecular risk strata define the incidence and pattern of failure in medulloblastoma following risk-adapted radiotherapy and dose-intensive chemotherapy: results from a phase III multi-institutional study. Neuro Oncol. 2022;24(7):1166-1175."},{"issue":"2","key":"bib4","series-title":"Int J Radiat Oncol Biol Phys","first-page":"269","article-title":"Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT \u201991","volume":"46","author":"Kortmann","year":"2000","unstructured":"Kortmann RDK\u00fchl JTimmermann BPostoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT \u201991. Int J Radiat Oncol Biol Phys. 2000;46(2):269-279."},{"issue":"5","key":"bib5","series-title":"Eur J Cancer","first-page":"727","article-title":"Outcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP\/UKCCSG PNET-3 chemotherapy","volume":"41","author":"Taylor","year":"2005","unstructured":"Taylor REBailey CCRobinson KJOutcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP\/UKCCSG PNET-3 chemotherapy. Eur J Cancer. 2005;41(5):727-734."},{"issue":"7","key":"bib6","series-title":"Cancer","first-page":"1600","article-title":"The change in patterns of relapse in medulloblastoma","volume":"68","author":"Tarbell","year":"1991","unstructured":"Tarbell NJLoeffler JSSilver BThe change in patterns of relapse in medulloblastoma. Cancer. 1991;68(7):1600-1604."},{"issue":"2","key":"bib7","series-title":"J Neurooncol","first-page":"187","article-title":"Extraneural metastasis in intracranial tumors in children: the experience of a single center","volume":"79","author":"Varan","year":"2006","unstructured":"Varan ASari NAkalan NExtraneural metastasis in intracranial tumors in children: the experience of a single center. J Neurooncol. 2006;79(2):187-190."},{"issue":"4","key":"bib8","series-title":"Acta Neuropathol","first-page":"309","article-title":"Extraneural metastases of paediatric brain tumours","volume":"105","author":"Rickert","year":"2003","unstructured":"Rickert CH.Extraneural metastases of paediatric brain tumours. Acta Neuropathol. 2003;105(4):309-327."},{"issue":"12","key":"bib9","series-title":"Cells","first-page":"1051","article-title":"Hypercalcemia in cancer: causes, effects, and treatment strategies","volume":"13","author":"Bartkiewicz","year":"2024","unstructured":"Bartkiewicz PKunachowicz DFilipski MStebel ALigoda JRembia\u0142kowska N.Hypercalcemia in cancer: causes, effects, and treatment strategies. Cells. 2024;13(12):1051."},{"issue":"4","key":"bib10","series-title":"Neuro Endocrinol Lett","first-page":"547","article-title":"Hypercalcemia in glioblastoma multiforme","volume":"27","author":"Seif","year":"2006","unstructured":"Seif FEAzar SBarake MSawaya R.Hypercalcemia in glioblastoma multiforme. Neuro Endocrinol Lett. 2006;27(4):547-548."},{"issue":"2","key":"bib11","series-title":"Med Pediatr Oncol","first-page":"126","article-title":"Brief report: medulloblastoma with widespread skeletal metastases presenting with hypercalcemia","volume":"33","author":"Aky\u00fcz","year":"1999","unstructured":"Aky\u00fcz CYal\u00e7in BKutluk TCila AB\u00fcy\u00fckpamuk\u00e7u M.Brief report: medulloblastoma with widespread skeletal metastases presenting with hypercalcemia. Med Pediatr Oncol. 1999;33(2):126-128."},{"issue":"4","key":"bib12","series-title":"Eur J Pediatr","first-page":"434","article-title":"Hypercalcaemia in cerebellar medulloblastoma: pathogenesis of solid tumour-associated hypercalcaemia","volume":"146","author":"Arisaka","year":"1987","unstructured":"Arisaka OObinata KYabuta KIshimoto KSato K.Hypercalcaemia in cerebellar medulloblastoma: pathogenesis of solid tumour-associated hypercalcaemia. Eur J Pediatr. 1987;146(4):434-436."},{"issue":"6","key":"bib13","series-title":"Horm Res","first-page":"268","article-title":"Hypercalcaemia in relapsed medulloblastoma 8 years post-diagnosis; evidence to support PTHrP production by medulloblastoma cells","volume":"66","author":"Dharmaraj","year":"2006","unstructured":"Dharmaraj PBall SJohnstone HHypercalcaemia in relapsed medulloblastoma 8 years post-diagnosis; evidence to support PTHrP production by medulloblastoma cells. Horm Res. 2006;66(6):268-272."},{"issue":"3","key":"bib14","series-title":"Clin Neurol Neurosurg","first-page":"323","article-title":"Skeletal spread of an anaplastic astrocytoma (WHO grade III) and preservation of histopathological properties within metastases","volume":"115","author":"Martens","year":"2013","unstructured":"Martens TMatschke JM\u00fcller CSkeletal spread of an anaplastic astrocytoma (WHO grade III) and preservation of histopathological properties within metastases. Clin Neurol Neurosurg. 2013;115(3):323-328."},{"issue":"6","key":"bib15","series-title":"Tumori","first-page":"808","article-title":"Bone marrow metastases from anaplastic oligodendroglioma presenting with pancytopenia and hypogammaglobulinemia: a case report","volume":"97","author":"Cordiano","year":"2011","unstructured":"Cordiano VMiserocchi FStorti M.Bone marrow metastases from anaplastic oligodendroglioma presenting with pancytopenia and hypogammaglobulinemia: a case report. Tumori. 2011;97(6):808-811."},{"issue":"4","key":"bib16","series-title":"Med Pediatr Oncol","first-page":"295","article-title":"Cytogenetic abnormalities in a disseminated medulloblastoma","volume":"21","author":"Stuart","year":"1993","unstructured":"Stuart AGPearson ADEmslie JCytogenetic abnormalities in a disseminated medulloblastoma. Med Pediatr Oncol. 1993;21(4):295-298."},{"issue":"1","key":"bib17","series-title":"Endocr Pract","first-page":"67","article-title":"Congenital craniopharyngioma and hypercalcemia induced by parathyroid hormone-related protein","volume":"13","author":"Brown","year":"2007","unstructured":"Brown JLBurton DWDeftos LJSmith AAPincus DWHaller MJ.Congenital craniopharyngioma and hypercalcemia induced by parathyroid hormone-related protein. Endocr Pract. 2007;13(1):67-71."},{"issue":"6","key":"bib18","series-title":"Intern Med","first-page":"486","article-title":"Hypercalcemia accompanied by hypothalamic hypopituitarism, central diabetes inspidus and hyperthyroidism","volume":"38","author":"Wada","year":"1999","unstructured":"Wada SKurihara SImamaki KHypercalcemia accompanied by hypothalamic hypopituitarism, central diabetes inspidus and hyperthyroidism. Intern Med. 1999;38(6):486-490."},{"key":"bib19","series-title":"J Neurosurg","first-page":"186","article-title":"Extracranial metastases of a glioblastoma multiforme","volume":"19","author":"Wisiol","year":"1962","unstructured":"Wisiol ESHandler SFrench LA.Extracranial metastases of a glioblastoma multiforme. J Neurosurg. 1962;19:186-194."},{"key":"bib20","series-title":"WHO Classification of Tumours:","author":"The WHO Classification of Tumours Editorial Board","year":"2021","unstructured":"The WHO Classification of Tumours Editorial Board.WHO Classification of Tumours: Central Nervous System Tumours. 5th ed. IARC; 2021."},{"issue":"4","key":"bib21","series-title":"Acta Neuropathol","first-page":"615","article-title":"Rapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples","volume":"123","author":"Northcott","year":"2012","unstructured":"Northcott PAShih DJRemke MRapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples. Acta Neuropathol. 2012;123(4):615-626."},{"issue":"9","key":"bib22","series-title":"Neuro Oncol","first-page":"1236","article-title":"Phase II study of irinotecan in combination with temozolomide (TEMIRI) in children with recurrent or refractory medulloblastoma: a joint ITCC and SIOPE brain tumor study","volume":"15","author":"Grill","year":"2013","unstructured":"Grill JGeoerger BGesner LPhase II study of irinotecan in combination with temozolomide (TEMIRI) in children with recurrent or refractory medulloblastoma: a joint ITCC and SIOPE brain tumor study. Neuro Oncol. 2013;15(9):1236-1243."},{"issue":"3","key":"bib23","series-title":"J Neurooncol","first-page":"515","article-title":"Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study","volume":"129","author":"Sabel","year":"2016","unstructured":"Sabel MFleischhack GTippelt SRelapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol. 2016;129(3):515-524."},{"issue":"12","key":"bib24","series-title":"Lancet Child Adolesc Health","first-page":"865","article-title":"Time, pattern, and outcome of medulloblastoma relapse and their association with tumour biology at diagnosis and therapy: a multicentre cohort study","volume":"4","author":"Hill","year":"2020","unstructured":"Hill RMRichardson SSchwalbe ECTime, pattern, and outcome of medulloblastoma relapse and their association with tumour biology at diagnosis and therapy: a multicentre cohort study. Lancet Child Adolesc Health. 2020;4(12):865-874."},{"issue":"1","key":"bib25","series-title":"J Neurol Neurosurg Psychiatry","first-page":"80","article-title":"Extracranial metastases of medulloblastoma in adults: literature review","volume":"54","author":"Rochkind","year":"1991","unstructured":"Rochkind SBlatt ISadeh MGoldhammer Y.Extracranial metastases of medulloblastoma in adults: literature review. J Neurol Neurosurg Psychiatry. 1991;54(1):80-86."},{"issue":"1","key":"bib26","series-title":"Int J Radiat Oncol Biol Phys","first-page":"72","article-title":"Prognostic factors after extraneural metastasis of medulloblastoma","volume":"78","author":"Mazloom","year":"2010","unstructured":"Mazloom AZangeneh AHPaulino AC.Prognostic factors after extraneural metastasis of medulloblastoma. Int J Radiat Oncol Biol Phys. 2010;78(1):72-78."},{"issue":"4","key":"bib27","series-title":"Asian J Neurosurg","first-page":"331","article-title":"A case of early extraneural medulloblastoma metastases in a young adult","volume":"10","author":"Kondoff","year":"2015","unstructured":"Kondoff SIMilev MDLaleva LNA case of early extraneural medulloblastoma metastases in a young adult. Asian J Neurosurg. 2015;10(4):331-333."},{"issue":"4","key":"bib28","series-title":"Oncol Lett","first-page":"2295","article-title":"Medulloblastoma with soft-tissue and skeletal metastases in an adult: a case report","volume":"10","author":"Geng","year":"2015","unstructured":"Geng DSong XLiu JYu ZNing F.Medulloblastoma with soft-tissue and skeletal metastases in an adult: a case report. Oncol Lett. 2015;10(4):2295-2298."},{"issue":"5","key":"bib29","series-title":"Clin Nucl Med","first-page":"354","article-title":"Extraneural metastases from desmoplastic medulloblastoma masquerading as lymphoma","volume":"42","author":"Mahajan","year":"2017","unstructured":"Mahajan APaul PSridhar EExtraneural metastases from desmoplastic medulloblastoma masquerading as lymphoma. Clin Nucl Med. 2017;42(5):354-357."},{"issue":"11","key":"bib30","series-title":"Oncotarget","first-page":"10175","article-title":"Recurrent extraneural sonic hedgehog medulloblastoma exhibiting sustained response to vismodegib and temozolomide monotherapies and inter-metastatic molecular heterogeneity at progression","volume":"9","author":"Petrirena","year":"2018","unstructured":"Petrirena GJMasliah-Planchon JSala QRecurrent extraneural sonic hedgehog medulloblastoma exhibiting sustained response to vismodegib and temozolomide monotherapies and inter-metastatic molecular heterogeneity at progression. Oncotarget. 2018;9(11):10175-10183."},{"issue":"1","key":"bib31","series-title":"Pediatr Neurosurg","first-page":"71","article-title":"Cervical extraneural lymph node metastasis in a patient with medulloblastoma","volume":"54","author":"Ata\u015f","year":"2019","unstructured":"Ata\u015f EVaran AAky\u00fcz CAkalan NB\u00fcy\u00fckpamuk\u00e7u M.Cervical extraneural lymph node metastasis in a patient with medulloblastoma. Pediatr Neurosurg. 2019;54(1):71-73."},{"issue":"2","key":"bib32","series-title":"J Pediatr Hematol Oncol","first-page":"e593","article-title":"Isolated bone recurrence of medulloblastoma with MYCN amplification and TP53 loss: a case report","volume":"44","author":"Takahashi","year":"2022","unstructured":"Takahashi YKudo KOgawa KIsolated bone recurrence of medulloblastoma with MYCN amplification and TP53 loss: a case report. J Pediatr Hematol Oncol. 2022;44(2):e593-e596."},{"issue":"2","key":"bib33","series-title":"Cureus","first-page":"e34732","article-title":"Recurrent extraneural metastatic medulloblastoma in an adult presenting with a superscan and treated with radium-223","volume":"15","author":"Mou","year":"2023","unstructured":"Mou BCruz-Lim EM.Recurrent extraneural metastatic medulloblastoma in an adult presenting with a superscan and treated with radium-223. Cureus. 2023;15(2):e34732."},{"issue":"5","key":"bib34","series-title":"Cureus","first-page":"e61339","article-title":"Cervical lymph node metastasis from medulloblastoma in a young adult: case report and literature review","volume":"16","author":"Harrak","year":"2024","unstructured":"Harrak MKamal SZerbani HCervical lymph node metastasis from medulloblastoma in a young adult: case report and literature review. Cureus. 2024;16(5):e61339."},{"issue":"2","key":"bib35","series-title":"J Neurooncol","first-page":"419","article-title":"Extraneuraxial metastases in medulloblastoma: is histology and molecular biology important?","volume":"135","author":"Gupta","year":"2017","unstructured":"Gupta TDasgupta AEpari SShirsat NChinnaswamy GJalali R.Extraneuraxial metastases in medulloblastoma: is histology and molecular biology important? J Neurooncol. 2017;135(2):419-421."},{"issue":"10","key":"bib36","series-title":"Am J Clin Oncol","first-page":"1015","article-title":"Patterns of failure in patients with adult medulloblastoma presenting without extraneural metastasis","volume":"41","author":"Mokhtech","year":"2018","unstructured":"Mokhtech MMorris CGIndelicato DJRutenberg MSAmdur RJ.Patterns of failure in patients with adult medulloblastoma presenting without extraneural metastasis. Am J Clin Oncol. 2018;41(10):1015-1018."},{"issue":"2","key":"bib37","series-title":"J Investig Med High Impact Case Rep","first-page":"2324709614532798","article-title":"Medulloblastoma in an adult with late extraneural metastases to the mediastinum","volume":"2","author":"Ghose","year":"2014","unstructured":"Ghose AMorris JCBreneman JCEssell JWang JBenzaquen S.Medulloblastoma in an adult with late extraneural metastases to the mediastinum. J Investig Med High Impact Case Rep. 2014;2(2):2324709614532798."},{"issue":"3","key":"bib38","series-title":"Neurosurgery","first-page":"623","article-title":"Adult medulloblastoma: prognostic factors and patterns of relapse","volume":"47","author":"Chan","year":"2000","unstructured":"Chan AWTarbell NJBlack PMAdult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery. 2000;47(3):623-632."},{"issue":"4","key":"bib39","series-title":"Pediatr Blood Cancer","first-page":"611","article-title":"Extraneural metastases of medulloblastoma: desmoplastic variants may have prolonged survival","volume":"62","author":"Young","year":"2015","unstructured":"Young RJKhakoo YYhu SExtraneural metastases of medulloblastoma: desmoplastic variants may have prolonged survival. Pediatr Blood Cancer. 2015;62(4):611-615."},{"issue":"2","key":"bib40","series-title":"J Pediatr Neurosci","first-page":"168","article-title":"Subcutaneous metastasis in medulloblastoma: a case report and review of literature","volume":"8","author":"Maiti","year":"2013","unstructured":"Maiti TSabharwal PPandey PDevi BI.Subcutaneous metastasis in medulloblastoma: a case report and review of literature. J Pediatr Neurosci. 2013;8(2):168-170."},{"issue":"1","key":"bib41","series-title":"Acta Neurol Belg","first-page":"247","article-title":"From cerebellum to skeleton: a case report of SHH-activated medulloblastoma with extraneural spread","volume":"125","author":"Marzouki","year":"2025","unstructured":"Marzouki SDe Vulder NDekeyzer S.From cerebellum to skeleton: a case report of SHH-activated medulloblastoma with extraneural spread. Acta Neurol Belg. 2025;125(1):247-252."},{"issue":"6","key":"bib42","series-title":"J Clin Invest","first-page":"1803","article-title":"Parathyroid hormonelike protein from human renal carcinoma cells. Structural and functional homology with parathyroid hormone","volume":"80","author":"Strewler","year":"1987","unstructured":"Strewler GJStern PHJacobs JWParathyroid hormonelike protein from human renal carcinoma cells. Structural and functional homology with parathyroid hormone. J Clin Invest. 1987;80(6):1803-1807."},{"key":"bib43","series-title":"Clin Neurol Neurosurg","first-page":"239","article-title":"A systematic review of shunt-related extraneural metastases of primary central nervous system tumors","volume":"174","author":"Xu","year":"2018","unstructured":"Xu KKhine KTOoi YCQuinsey CS.A systematic review of shunt-related extraneural metastases of primary central nervous system tumors. Clin Neurol Neurosurg. 2018;174:239-243."},{"issue":"23","key":"bib44","series-title":"J Clin Oncol","first-page":"2936","article-title":"High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)","volume":"31","author":"Tarbell","year":"2013","unstructured":"TarbellNJFriedman HPolkinghorn WRet al.High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031). J Clin Oncol. 2013;31(23):2936-2941."},{"issue":"1","key":"bib45","series-title":"BMC Med Genet","first-page":"10","article-title":"A case of molecularly profiled extraneural medulloblastoma metastases in a child","volume":"19","author":"Mobark","year":"2018","unstructured":"Mobark NAAl-Harbi MMosleh OSantagata SSnuderl MAbedalthagafi M.A case of molecularly profiled extraneural medulloblastoma metastases in a child. BMC Med Genet. 2018;19(1):10."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/19\/article-CASE25318.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/19\/article-CASE25318.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/19\/article-CASE25318.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:12:00Z","timestamp":1769685120000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/19\/article-CASE25318.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":90,"journal-issue":{"issue":"19"},"URL":"https:\/\/doi.org\/10.3171\/case25318","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,10]]}}}