Would you consider spinal cord biopsy for an intramedullary cord lesion with disabling neurological deficits and no diagnosis despite a comprehensive workup?   

I would probably do a literary research, and then ask my neurosurgical colleagues if they have had any experience doing that. If they are unsure, I would use the web to track down centers that have a high workload experience of doing a biopsy and direct the patient to be seen at that center provided...

The location is probably the most important issue (central cord versus eccentric lesion in the dorsal column). If there is any meningeal involvement in imaging, may also be better off getting a meningeal sample. However, for progressive spinal cord lesions without response to empiric treatment, a bi...