Comment: Cervical epidural neurosarcoidosis – A case report and literature review
We read with great interest the manuscript by Khairy et al. about “Cervical epidural neurosarcoidosis: a case report and literature review.” 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. 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.” 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.