Early isolated C7 vertebral body metastasis following temporal gliosarcoma resection: Pathophysiological insights and practice-oriented management framework

Background: Gliosarcoma (GS) is a rare high-grade glioma characterized by a biphasic glial-mesenchymal histology. Compared with conventional glioblastoma, GS demonstrates a greater propensity for extracranial dissemination. However, isolated vertebral metastasis remains exceptionally uncommon. Case Description: A 45-year-old man underwent gross-total resection of a left temporal GS followed by standard concomitant chemoradiotherapy. Baseline post-resection whole-body computed tomography (CT) staging was negative for systemic metastasis. Brain magnetic resonance imaging (MRI) at 5 months confirmed complete local intracranial control. At 6 months post-resection, he developed severe cervical pain and bilateral C7–C8 radiculopathy. Cervical MRI revealed destructive lysis of the C7 body with epidural extension causing severe spinal cord compression (Grade 3). Repeat systemic staging CT confirmed C7 as the solitary site of recurrence. An urgent anterior C7 corpectomy, expandable titanium cage placement, and plate stabilization were performed. Intraoperatively, the tumor was confined to the vertebral body, with an intact posterior longitudinal ligament and dura, strongly supporting hematogenous dissemination. Histopathology confirmed metastatic biphasic GS. Neurological decompression provided immediate pain relief and motor recovery. Conclusion: Vertebral metastasis from GS may occur early despite satisfactory intracranial control. New axial or radicular spinal symptoms should prompt early spinal imaging. In appropriately selected patients with neurological compression or mechanical instability, decompression and stabilization may provide rapid symptomatic and functional benefit despite the aggressive systemic course of the disease.