Trigeminal Neurosarcoidosis as a Neurosurgical Dilemma: A Literature Review and Illustrative Case.

[INTRODUCTION/BACKGROUND] Neurosarcoidosis is an uncommon manifestation of systemic sarcoidosis, and isolated cranial nerve involvement is exceptionally rare; therefore, histological biopsy is essential to confirm diagnosis. Isolated trigeminal neurosarcoidosis (TNS), often radiologically mimics common tumors like schwannoma or meningioma, thereby posing a significant diagnostic dilemma.

[OBJECTIVE] To present a review on TNS and its clinical implications.

[METHODS AND MATERIALS] A PubMed literature search comprising articles published in English language was conducted till date. The data was compiled to gain information on demographics, clinic-radiological features, treatment and outcome characteristics. In addition, the authors add an illustrative case from their department.

[RESULTS] A total of 14 such cases have been published so far which showed a female predilection and mean age of 38.1 ± 11.8 years. Our patient was a 38 year old female with progressive trigeminal neuropathy masquerading as a trigeminal schwannoma. Only three out of 15 cases, including ours, had bilateral presentation (20%) with homogeneous contrast enhancement in all cases. In all cases, tissue biopsy was required for definitive diagnosis.

[CONCLUSION] Isolated TNS poses a diagnostic dilemma. Radiologically, it can closely mimic benign nerve sheath tumors, making frozen biopsy crucial in guiding intraoperative decision-making. When neurosarcoidosis is suspected, surgery should be limited to biopsy or partial resection to establish diagnosis and minimize morbidity, with subsequent medical management forming the mainstay of treatment.