Concomitant cerebellum subdural seeding and spinal epidural metastasis of pineal germinoma

Pineal region lesions in adults brings up various considerations. Central nervous system (CNS) germinoma should be considered. Cerebrospinal fluid (CSF) seeding is the main route of CNS germinoma dissemination. The spinal seeding rate has been reported to be 5-20%. Spinal epidural metastasis from CNS germinoma is very rare. Only one case report had been reported in the literature. Here, we report a 43 year-old man with pineal germinoma developing concomitant cerebellum subdural and spinal epidural metastasis 2 years after the right occipital transtentorial approach with total removal of the tumor and radiation. The literature reviews of the seeding mechanism and treatment modality will be discussed.