Sarcoidosis rarely manifests by involving the cranial nerves exclusively. A 35-year-old woman presented with bilateral cavernous sinus masses and symptoms of trigeminal neuropathy. Computed tomography and magnetic resonance imaging suggested an intracranial tumor, favoring a meningioma. The patient underwent emergent surgical decompression and tumor excision. Histopathology of the resected tumor revealed classic features of sarcoidosis, and she received steroid treatment accordingly. Neurosarcoidosis must be considered in the differential diagnosis of idiopathic cranial neuropathies to avoid unnecessary surgery, since surgery has little, if any, role in the treatment of sarcoidosis. In the absence of primary organ involvement, radiologic diagnosis of cranial nerve sarcoidosis is unreliable; histopathology is required to reach a definitive diagnosis.
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