INTRASPINAL SARCOIDOSIS - DIAGNOSIS AND MANAGEMENT

OBJECTIVE Isolated intramedullary spinal cord or cauda equina involvem ent by sarcoidosis is quite rare. We report three patients with intras pinal sarcoidosis and absent systemic manifestations of the disease. T he clinical presentation, operative management, electrophysiologic stu dies, pathology, laboratory investigations, and current therapy are di scussed with attention to the previous literature.METHODS Two the thre e patients had a preoperative diagnosis of a cervical intramedullary s pinal cord tumor. The third patient had the preoperative diagnosis of an infectious process involving the cauda equina. Magnetic resonance i maging (MRI) with gadolinium did not suggest an inflammatory process. Intraoperative somatosensory evoked potential performed in two patient s exhibited normal amplitudes, but a prolonged latency in seven out of eight extremities; with normal central conduction time suggesting a p eripheral or radicular involvement. All three patients underwent lamin ectomy and biopsy of the intraspinal pathology. RESULTS Pathologic exa mination demonstrated sarcoidosis in all three patients. Intraoperativ e observations, intramedullary nodules, and thickening of the meninges were inconsistent with neoplasm and limited the surgical procedure to a biopsy. Frozen sections performed at two of the operations revealed an inflammatory process that confirmed the intraoperative observation s. Postoperatively, the diagnostic work-up for all patients was negati ve for systemic manifestations. CONCLUSIONS Isolated intraspinal sarco idosis is a rare process; The current management for intramedullary sp inal cord or cauda equina sarcoidosis is prolonged corticosteroids. Th e surgeon should not attempt complete resection if this granulomatous process is suspected. (C) 1997 by Elsevier Science Inc.