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Medulloblastoma is a rare adult primary brain tumor and its presence in the cerebellopontine angle (CPA) constitutes an even rarer site for origin. There are only 40 reported cases of CPA medulloblastoma in the literature, with most being intra-axial and occurring in the pediatric population. Extra-axial CPA medulloblastoma in adults are extremely rare and only 10 adult cases have been reported in world literature.We report a rare case of primary extra-axial CPA medulloblastoma occurring in an adult. We review the literature for such an unusual presentation of medulloblastoma in adults and discuss its appropriate clinico-radiological features along with its possible pathogenesis and surgical management.With increasing reporting of such tumors, CPA region, medulloblastoma should be considered a differential diagnosis of intra-axial or extra-axial CPA tumor, as their further management and prognosis differ significantly. Adjuvant radiotherapy and combined chemotherapy regimen should be added to the postoperative management.

<b><i>Introduction:</i></b> Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old). <b><i>Case Presentation:</i></b> We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Under conscious sedation protocol, cortical and subcortical mapping, and electrocorticography, gross total resection was achieved. In both the cases, there were no postoperative neurodeficits or perioperative complications. <b><i>Conclusion:</i></b> Our 2 cases illustrate the first instance of successful use of awake IONM for maximal safe resection of ERG in preadolescent age-group. We believe, with proper preoperative planning and careful titration of anesthetics, it is safe and feasible. The blanket notion that preadolescent age-group should be excluded from awake mapping needs to be challenged, rather curated on a case basis.

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