Spinal neurosarcoidosis mimicking intramedullary tumors without systemic symptoms: Report of two cases and a systematic review

Background: Intramedullary spinal neurosarcoidosis is a rare manifestation of sarcoidosis that can mimic intramedullary spinal cord tumors, especially in the absence of systemic symptoms. Its diagnosis is challenging, and management requires a multidisciplinary approach. Case Description: We report two previously healthy male patients presenting with progressive myelopathy due to tumor-like intramedullary lesions. In both cases, limited decompression and diagnostic biopsy revealed noncaseating granulomas consistent with neurosarcoidosis. Postoperative corticosteroid therapy resulted in significant and sustained neurological recovery. One patient required reoperation for mechanical recompression at the cervicothoracic junction. At the latest follow-up, both patients remained relapse-free. A systematic review of surgically treated, histopathology-confirmed intramedullary spinal sarcoidosis cases ( n = 15) identified the cervical and cervicothoracic regions as the most common locations. Diagnostic laminectomy was the predominant surgical approach, with gross total resection being rare. Most patients improved neurologically after corticosteroid therapy, although relapses occasionally occurred. Conclusion: Intramedullary neurosarcoidosis may closely resemble spinal cord tumors in imaging and clinical presentation. Early suspicion, integration of magnetic resonance imaging and cerebrospinal fluid findings, and a conservative surgical approach followed by immunosuppressive therapy can improve outcomes and avoid unnecessary aggressive resections.