Treatment strategies for relapsed medulloblastoma in the pediatric population: illustrative case.

backgroundRelapsed medulloblastoma (MB) remains a significant cause of pediatric cancer mortality, accounting for approximately 10% of all childhood cancer deaths. Despite advances in molecular characterization and treatment of primary MB, no standardized protocol currently exists for managing recurrence. This case highlights a novel approach to treating relapsed MB and aims to contribute to the evolving understanding of optimal strategies in this setting. OBSERVATIONS: The authors describe the case of a pediatric patient with relapsed MB, characterized as group 4 MB , managed with a personalized treatment approach involving repeat craniospinal irradiation, chemotherapy, and bone marrow transplant. In parallel, they review current literature and ongoing clinical trials to contextualize this strategy within the broader landscape of relapsed MB management. The case underscores the heterogeneity in treatment approaches and the lack of consensus regarding best practices. At the time of this report, the patient is approximately 6 months post-bone marrow transplant and continues to be monitored for signs of disease recurrence. LESSONS: This case illustrates the importance of an individualized, multidisciplinary approach to relapsed MB, accounting for prior therapies, tumor biology, and patient goals. Ongoing research and collaboration are essential to establishing more effective, evidence-based standards of care for this challenging diagnosis. https://thejns.org/doi/10.3171/CASE25612.