A neurosurgical approach to skull metastasis from uterine leiomyosarcoma: illustrative case.

backgroundLeiomyosarcoma (LMS), a smooth muscle-derived tumor, is associated with a poor prognosis and a high potential for metastasis to local and distal sites. Skull metastases are exceptionally rare, with few cases documented in the literature. Diagnosing and treating these lesions is challenging due to their nonspecific clinical presentation and imaging similarities to other tumors. OBSERVATIONS: The authors report the case of a 46-year-old female with a 4-month history of a right parietal tumor, accompanied by headaches and left hemiparesis. MRI revealed a heterogeneous, intra- and extra-axial lesion with irregular margins in the right parietal region. Resection of the tumor was performed, and histopathological findings confirmed a diagnosis of metastatic LMS involving the bone and dura. Postoperative radiotherapy was administered, and the patient showed no evidence of recurrence 1 year after initial treatment. A review of the past 30 years of existing case reports of uterine LMS (uLMS) with cranial and intracranial metastases is also provided. LESSONS: This report highlights the diagnostic and therapeutic complexity of metastatic LMS to the skull. Adjuvant radiotherapy might prove advantageous in improving the prognosis of patients with uLMS, underscoring the significance of integrating clinical, radiological, histopathological, and immunohistochemical findings for accurate diagnosis and management. https://thejns.org/doi/10.3171/CASE24769.