• Matthew L Carlson, James R White, Mana Espahbodi, David S Haynes, Colin L W Driscoll, Allen J Aksamit, Siddharama Pawate, John I Lane, and Michael J Link.
• *Departments of Otolaryngology-Head and Neck Surgery, †Neurologic Surgery, ‡Radiology, and §Neurology, Mayo Clinic School of Medicine, Rochester, MN, U.S.A.; and ∥Departments of Otolaryngology-Head and Neck Surgery, ¶Neurology, Vanderbilt University Medical Center, Nashville, TN, U.S.A.
• Otol. Neurotol. 2015 Jan 1; 36 (1): 156-66.

ObjectiveNeurosarcoidosis is a rare granulomatous disease that can result in cranial neuropathy, chronic meningitis, and intracranial granuloma formation. Meningeal involvement may cause focal nodular enhancement that can simulate common cranial base tumors. The objective of the current study is to further define the clinical features of neurosarcoidosis in a large cohort of patients, focusing on characteristics relevant to the skull base surgeon.Study DesignRetrospective series.SettingTwo tertiary academic referral centers.PatientsConsecutive patients diagnosed with neurosarcoidosis.Intervention(S)Review of clinical presentation, physical examination, radiologic findings, biopsy results, and laboratory testing.Main Outcome MeasuresPrevalence and distribution of cranial neuropathy, radiologic features of meningeal enhancement, and patterns of simulated tumors.ResultsA total of 305 patients met study criteria. The mean age at diagnosis was 47 years and 53% were female. The optic nerve was the most commonly involved cranial nerve, followed by the trigeminal and the facial nerve. Meningeal enhancement was present in 67% of cases with 17% demonstrating focal or multicentric nodular enhancement simulating tumor. The most common locations of inflammatory tumor development included the cavernous sinus, petrous temporal bone, and sphenoid wing; six patients had bilateral internal auditory canal lesions, several mimicking neurofibromatosis type II.ConclusionEstablishing the diagnosis of neurosarcoidosis remains challenging. Meningeal involvement and cranial neuropathy often mimic other more common conditions. Careful review of patient history and clinical imaging can reveal important clues toward the diagnosis of neurosarcoidosis. The clinician must maintain a high index of suspicion in patients with atypical presentation to avoid misdiagnosis and facilitate early medical treatment.

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