Interdisciplinary Neurosurgery · Published 2026-07-14 · DOI 10.1016/j.inat.2026.102327
Tsung-Han Cheng, Po-Hsin Lin, Sheng-Han Huang, Hong Kai Wang, Cheng-Yu Li, Kuan-Hung Chen, Ying-Ching Li, Yu-Jen Lu
We report a rare case of high cervical (C1–C2) intradural intramedullary spinal cord metastasis (IDIM) with concurrent leptomeningeal involvement originating from HER2-positive (3+) breast carcinoma. A 57-year-old woman (McCormick Grade IV; Karnofsky Performance Status 40) with widely metastatic disease underwent urgent C1–C3 laminectomy and subtotal resection following rapid neurological deterioration. Gadolinium-enhanced MRI revealed characteristic rim and flame signs with a nine-segment T2 hyperintensity and associated syrinx. Histopathology confirmed a breast primary (CK7+, GATA-3+, TRPS1+). Despite surgery and palliative radiotherapy, the patient developed flaccid quadriplegia and transitioned to home-based supportive care, an outcome that did not demonstrate neurological benefit from surgical intervention. This case highlights the extreme rarity of C1–C2 IDIM from breast cancer, the ethical and clinical complexity of surgical decision-making below conventional prognostic thresholds—including a transparent discussion of an outcome without demonstrated benefit—and the emerging role of CNS-penetrant HER2-directed therapy in molecularly defined IDIM.
Abstract from DOAJ. Public domain (CC0 1.0).
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Cheng, T., Lin, P., Huang, S., et al. (2026). C1–C2 intramedullary metastasis of HER2-positive breast Cancer with concurrent leptomeningeal involvement: A case report and surgical decision-making review. Interdisciplinary Neurosurgery. https://doi.org/10.1016/j.inat.2026.102327