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Letter to the Editor

Comment: Cervical epidural neurosarcoidosis – A case report and literature review

Department of Neurology, Complexo Hospital de Clínicas UFPR,
Department of Medicine, Universidade Positivo, Curitiba, Paraná, Brazil.
Corresponding author: Otto Hernandez Fustes, Department of Neurology, Complexo Hospital de Clínicas UFPR, Avenida Marechal Floriano Peixoto 170, Curitiba, Paraná, Brazil.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Hernandez Fustes O, Arteaga Rodriguez C. Comment: Cervical epidural neurosarcoidosis – A case report and literature review. Surg Neurol Int 2020;11:213.

Dear Editor,

We read with great interest the manuscript by Khairy et al. about “Cervical epidural neurosarcoidosis: a case report and literature review.”[1] We think the article offers a good opportunity for resident physicians and specialists to review the very rare neurological manifestations of sarcoidosis. Sarcoidosis is an autoimmune/inflammatory disorder characterized as a multisystem disease resulting in granulomas affecting many tissues. In 1905, Winckler was one of the first to study the neurological manifestations of sarcoidosis.[2] In 2020, Kidd reviewed the subject and found: “….of 19–54 cases, around half of the patients have isolated cranial neuropathies, of which the facial nerve is by far the most common, with peripheral nerve involvement in 10% muscle involvement in 5%, and with brain and spinal cord lesions accounting for the remaining; 16–70% of these series.”[2] Here Khairy et al. provided an excellent review of the clinical presentation of neurosarcoidosis, consisting of radiculopathy and/or myelopathy. They additionally discussed its classical MRI findings, along with appropriate surgical management. In addition, they presented a patient with impaired pin appreciation on the left side in the C2-C7 distributions. After several failed percutaneous biopsy attempts, an open anterior C5-C6 biopsy of the large extradural lesion identified on MRI proved to be histologically confirmed neurosarcoidosis. Our only additional recommendation would have been the utilization of intraoperative neurophysiological monitoring during the anterior surgical procedure, including electroneuromyography, somatosensory evoked potentials, and motor evoked potentials to avoid incurring an intraoperative neurological deficit. Finally, we congratulate the authors for their report and anticipate that future studies will shed more light on the clinical, radiographic, and surgical management of neurosarcoidosis.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , , . Cervical epidural neurosarcoidosis: A case report and literature review. Surg Neurol Int. 2020;11:133.
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  2. . Neurosarcoidosis: Clinical manifestations, investigation and treatment. Pract Neurol. 2020;20:199-212.
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