Stereotactic radiosurgery for progression of cerebellar liponeurocytoma after resection: illustrative case.

backgroundCerebellar liponeurocytoma (cLNC) is a rare neuronal tumor seen in the posterior fossa with a recognized risk of recurrence after subtotal resection; however, an optimal management strategy against recurrent disease remains uncertain. Here, the authors report a case of postoperative progression of cLNC that was successfully treated with Gamma Knife radiosurgery (GKRS). OBSERVATIONS: A patient presenting with headache was found to have a homogeneously enhancing tumor in the fourth ventricle involving the cerebellar vermis. Microsurgical resection was performed, and histopathological examination confirmed cLNC. Surveillance imaging demonstrated slow progression of the residual lesion over 1 year 8 months. Since repeat microsurgical resection was considered technically unfeasible due to the anatomically constrained location, salvage GKRS was performed with a marginal dose of 16 Gy. Follow-up imaging demonstrated durable local tumor control, and the patient remained neurologically stable without complications for 2 years 3 months. LESSONS: GKRS can provide durable local control of the postoperative progression of small residual cLNC. Treatment selection should consider tumor volume, anatomical constraints, and biological features, including proliferative indices and molecular profile. Regarding tumors with focal progression in anatomically constrained regions, stereotactic radiosurgery represents a promising and optimal salvage strategy. https://thejns.org/doi/10.3171/CASE26321.