This case illustrates the difficulty in being able to arrive at a firm pre-operative diagnosis, when features are a little atypical. In this case the age of the patient and protrusion through the 4th ventricular foramen favor an ependymoma, whereas the fact that the lesion arises from the vermis and presence of numerous supratentorial deposits favors a medulloblastoma (ependymomas tend to seed inferiorly).