Congenital dermal sinus tract (CDST) is a rare entity of spinal dysraphism with an incidence of 1 in 2500 live births. The presumed etiology relates to a focal failure of disjunction resulting in a persistent adhesion between the neural and cutaneous ectoderm. CDST is commonly associated with other pathologies such as myelomeningocele, split cord malformation, tethered cord and inclusion tumors. The authors report a case of a 2-year-old girl discharging lumbosacral CDST. The preoperative MRI showed the dermal sinus tract with 2 intradural lesions from L1 to L3. The tract was surgically excised followed by complete excision of the cyst and lipoma. The dermal sinus tract was attached to the medullary cone and was cut there, allowing “en bloc” removal of the dermal sinus tract. There were two distinct types of tumor. One cystic is located posterior to the medullary cone and the other is located laterally to the medullary cone, whose appearance suggests a lipoma. Both tumors were removed completely. The dura was closed in a tight manner. The pathological examination confirmed the lipoma and Dermoid Cyst. In the postoperative course, the child had a motor deficit in the lower limbs, which recovered completely after 3 months of physiotherapy.
References
[1]
Radmanesh, F., Nejat, F. and El Khashab, M. (2009) Dermal Sinus Tract of the Spine. Child’sNervousSystem, 26, 349-357. https://doi.org/10.1007/s00381-009-0962-z
[2]
Selçuki, M., Vatansever, S., Umur, A.S., Temiz, C. and Sayin, M. (2007) Apoptosis Seems to Be the Major Process While Surface and Neural Ectodermal Layers Detach during Neurulation. Child’sNervousSystem, 24, 577-580. https://doi.org/10.1007/s00381-007-0527-y
[3]
De Vloo, P., Lagae, L., Sciot, R., Demaerel, P., van Loon, J. and Van Calenbergh, F. (2013) Spinal Dermal Sinuses and Dermal Sinus-Like Stalks Analysis of 14 Cases with Suggestions for Embryologic Mechanisms Resulting in Dermal Sinus-Like Stalks. European Journal of Paediatric Neurology, 17, 575-584. https://doi.org/10.1016/j.ejpn.2013.04.003
[4]
Elton, S. and Oakes, W.J. (2001) Dermal Sinus Tracts of the Spine. NeurosurgicalFocus, 10, e4. https://doi.org/10.3171/foc.2001.10.1.5
[5]
Yamaguchi, S., Takeda, M., Kihara, H., Eguchi, K., Mitsuhara, T., Matsushige, T., et al. (2011) Lateral Buttock Congenital Dermal Sinus Tract—Case Report. Neurologiamedico-Chirurgica, 51, 460-462. https://doi.org/10.2176/nmc.51.460
[6]
Jindal, A. and Mahapatra, A.K. (2001) Spinal Congenital Dermal Sinus: An Experience of 23 Cases over 23 Years. Neurology India, 49, 243-246.
[7]
Martínez-Lage, J.F., Almagro, M.J., Ferri-Ñiguez, B., Izura Azanza, V., Serrano, C. and Domenech, E. (2010) Spinal Dermal Sinus and Pseudo-Dermal Sinus Tracts: Two Different Entities. Child’sNervousSystem, 27, 609-616. https://doi.org/10.1007/s00381-010-1308-6
[8]
Ackerman, L.L. and Menezes, A.H. (2003) Spinal Congenital Dermal Sinuses: A 30-Year Experience. Pediatrics, 112, 641-647. https://doi.org/10.1542/peds.112.3.641
[9]
Ikwueke, I., Bandara, S., Fishman, S.J. and Vargas, S.O. (2008) Congenital Dermal Sinus Tract in the Lateral Buttock: Unusual Presentation of a Typically Midline Lesion. JournalofPediatricSurgery, 43, 1200-1202. https://doi.org/10.1016/j.jpedsurg.2008.01.021
[10]
Tubbs, R.S., Frykman, P.K., Harmon, C.M., Oakes, W.J. and Wellons, J.C. (2006) An Unusual Sequelae of an Infected Persistent Dermal Sinus Tract. Child’sNervousSystem, 23, 569-571. https://doi.org/10.1007/s00381-006-0216-2
Martínez-Lage, J.F., Pérez-Espejo, M.A., Tortosa, J.G., Ros de San Pedro, J. and Ruiz-Espejo, A.M. (2006) Hydrocephalus in Intraspinal Dermoids and Dermal Sinuses: The Spectrum of an Uncommon Association in Children. Child’sNervousSystem, 22, 698-703. https://doi.org/10.1007/s00381-005-0029-8
