Abstract
<title>Abstract</title> <p>Background Craniopharyngioma is a benign tumor originating from Rathke's pouch remnants, but exhibiting aggressive growth despite histological benignity. It has a high recurrence rate (50–70%), with ectopic recurrence (outside the primary site) being rare (< 4.7%), primarily mediated by surgical seeding or cerebrospinal fluid (CSF) dissemination. Case presentation: A 28-year-old male with papillary craniopharyngioma in sellar experienced two ectopic recurrences: frontal lobe at 10 months after initial resection and lumbar spinal canal nearly 6 years later. Pathological examination confirmed papillary subtype in both recurrences. Treatment focused on surgical resection, with no adjuvant therapy administered. Conclusions This case highlights the importance of meticulous surgical technique to reduce dissemination risk and lifelong MRI surveillance for early detection. It reveals dual dissemination pathways (surgical seeding and CSF spread), emphasizing the need for further research into recurrence mechanisms and biomarkers.</p>