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Infected congenital lumbosacral dermal sinus tract with conus epidermoid abscess: a rare entity

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Abstract

Purpose

Dermal sinus is more commonly associated with intradural dermoid than an epidermoid cyst. Conus epidermoid cyst with dermal sinus is a rare entity. We are presenting a rare case of infected conus epidermoid cyst along with the dermal sinus in an 18-month-old girl presented with flaccid paraparesis with sphincter dysfunction and timely intervention leads to complete recovery. We had searched PubMed for previously reported similar cases and did a case-based review of the literature.

Case report

This 18-month-old girl with discharging lumbosacral sinus with fever since 3 days presented with flaccid paraparesis with sphincter dysfunction. Preoperative magnetic resonance imaging (MRI) showed a large enhancing lesion from L1-S1 along with the dermal sinus tract. Complete excision of the cyst along with the sinus tract, followed by long-term antibiotic therapy. The excision of the infected cyst was done through myelotomy under neuromonitoring, while some part of the capsule densely adherent to the neural tissue was left behind. The patient gradually improved following surgery and motor power of the lower limbs were \( \raisebox{1ex}{$3$}\!\left/ \!\raisebox{-1ex}{$5$}\right. \) while going home. Histopathology revealed epidermoid cyst with secondary inflammatory tissue. Follow-up MRI of the spine showed excision of the dermal sinus tract and cyst with postoperative changes. At 1-year follow-up, the patient was asymptomatic without any focal deficits.

Conclusion

Early surgical intervention followed by long-term antibiotic therapy is a must for good functional recovery in patients of an infected dermal sinus tract with associated cyst. While excising cyst through myelotomy, some part of the capsule densely adherent to neural tissue may be left behind. Regular follow-up in the first year of surgery is essential to look for the recurrence of the lesion.

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Authors and Affiliations

  1. Department of Neurosurgery, AIIMS, Raipur, 492099, India

    Surendra Kumar Gupta, Prashant Singh, Raghvendra Sharma & Lokesh S. Nehete

  2. Department of Pathology & Laboratory Medicine, AIIMS, Raipur, India

    Rakesh Kumar Gupta

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  1. Surendra Kumar Gupta
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  2. Prashant Singh
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  5. Lokesh S. Nehete
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Contributions

Conceptualization: Surendra Gupta, Lokesh Nehete

Methodology: Surendra Gupta, Prashant Singh, Lokesh Nehete

Formal analysis and investigation: Surendra Gupta, Lokesh Nehete, Rakesh Gupta, Raghvendra Sharma

Writing—original draft preparation: Surendra gupta, Lokesh Nehete

Writing—review and editing: Surendra gupta, Lokesh Nehete, Rakesh Gupta, Raghvendra Sharma, Prashant Singh

Supervision: Lokesh Nehete, Raghvendra Sharma

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Correspondence to Lokesh S. Nehete.

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Gupta, S.K., Singh, P., Gupta, R.K. et al. Infected congenital lumbosacral dermal sinus tract with conus epidermoid abscess: a rare entity. Childs Nerv Syst 37, 741–747 (2021). https://doi.org/10.1007/s00381-020-04987-8

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