Background: Medulloblastoma is the most common malignant pediatric central nervous system tumor and exhibits marked molecular and clinical heterogeneity. Immune evasion pathways may contribute to tumor aggressiveness and represent potential prognostic and therapeutic targets. We investigated the clinicopathological and prognostic relevance of the immune checkpoint molecules B7-H3 (CD276) and CD47 in medulloblastoma. Methods: We screened 77 patients treated between April 2015 and December 2025; in total, 32 patients with pathologically confirmed medulloblastoma and complete data were included. Tumor B7-H3 and CD47 expression was assessed using immunohistochemistry and an immunoreactivity score (IRS); patients were categorized as having negative/low (IRS < 4) or high (IRS ≥ 4) expression. We analyzed the associations with clinicopathological and molecular features. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan–Meier and log-rank tests. Prognostic factors were examined using univariate and multivariate Cox regression. Results: High B7-H3 expression was associated with shorter OS (median 46 vs. 85 months; p = 0.024) and markedly reduced DFS (median 21 vs. 102 months; p < 0.001). High CD47 expression was also associated with shorter OS (median 56 vs. 102 months; p = 0.025), whereas DFS did not significantly differ by CD47 status (p = 0.200). B7-H3 and CD47 expression levels were not correlated (Spearman’s rho = 0.071; p = 0.699). In the univariate analysis, high B7-H3 expression predicted mortality (HR = 25.79; p = 0.002) and recurrence risk (HR = 136.23; p = 0.045), and high CD47 expression predicted mortality (HR = 4.82; p = 0.042). In the multivariate analysis, high B7-H3 expression remained an independent predictor of poor OS (HR = 31.01; p = 0.004), whereas radiotherapy independently reduced the recurrence risk (HR = 0.197; p = 0.024). Conclusions: B7-H3 is a strong independent adverse prognostic biomarker for OS and is associated with profoundly shorter DFS in medulloblastoma, supporting its relevance as a candidate target for immune-directed strategies.

The gyrus rectus (GR) is located at the base of the anterior cranial fossa, above the prechiasmatic optic nerves and optic chiasm. Herniation of the GR has been reported secondary to idiopathic causes or space-occupying lesions of the frontal lobe. However, GR herniation following transsphenoidal pituitary surgery has not been described previously. A 51-year-old woman with no comorbidities other than diabetes presented with visual disturbance in the right eye. Imaging revealed a non-functioning pituitary macroadenoma compressing the optic chiasm from below. The patient underwent microscopic transsphenoidal resection of the pituitary adenoma, achieving total removal. Early postoperative recovery was uneventful. Six-month follow-up MRI demonstrated inferior herniation of the GR into the sellar cavity, compressing the optic nerves superiorly. Visual complaints partially improved without further progression. This case represents the first reported instance of GR herniation following transsphenoidal pituitary surgery. Awareness of this rare complication is essential when evaluating persistent or new-onset visual symptoms postoperatively.