Child's Nervous System

, Volume 22, Issue 10, pp 1307–1315 | Cite as

Anatomy and surgery of the infected dermal sinus of the lower spine

  • J. van AalstEmail author
  • E. A. M. Beuls
  • E. M. J. Cornips
  • L. Vanormelingen
  • M. Vandersteen
  • J. W. Weber
  • J. S. H. Vles
Original Paper



Cases of infected dermal sinus are scarce and detailed surgical anatomical descriptions are hardly found in literature. The clinical, radiological, and surgical findings in four cases of an infected dermal sinus located at the lower spine are presented to elucidate the pathological anatomical configuration.

Clinical material

The first case showed two dermal sinuses with a parallel course extra- and intradurally, ending in a confluence of cavities connected to the conus. In this case, as well as in the fourth case, the signs and symptoms were those of meningitis. The second case presented with meningitis and a subdural empyema, while the third case presented with an intradermoid–intramedullary abscess at the junction between the DS and the conus. This child probably showed signs and symptoms of conus involvement as early as during pregnancy.


The anatomy of the nervous elements in this congenital anomaly is heavily disturbed, more particularly in case of infection, due to extensive arachnoidal scarring. The latter renders dissection laborious and recognition of anatomical details difficult, resulting in complete excision of a dermal sinus in less than half of the cases. Despite their variability in presentation, most cases of an infected dermal sinus show similar characteristic features.


Dermal sinus Disjunction anomaly Dermoid tumor Intramedullary abscess Spinal subdural empyema 


  1. 1.
    Ackerman L, Menezes A, Follett K (2002) Cervical and thoracic dermal sinus tracts. Pediatr Neurosurg 37:137–147PubMedCrossRefGoogle Scholar
  2. 2.
    Barkovich AJ, Edwards M, Cogen PH (1991) MR evaluation of spinal dermal sinus tracts in children. AJNR Am J Neuroradiol 12:123–129PubMedGoogle Scholar
  3. 3.
    Benzil DL, Epstein MH, Knucky NW (1992) Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Case report. Neurosurgery 30:118–121PubMedCrossRefGoogle Scholar
  4. 4.
    Bruff P, Sgouros S (2002) Lumbar dermoid cyst causing pyomyelia in a child. Pediatr Neurosurg 36:162–163PubMedCrossRefGoogle Scholar
  5. 5.
    Byrne RW, von Roenn KA, Whisler WW (1994) Intramedullary abscess: a report of two cases and a review of the literature. Neurosurgery 35:321–326, discussion 326PubMedGoogle Scholar
  6. 6.
    Chen CY, Lin KL, Wang HS et al (1999) Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess. Pediatr Neurol 20:157–160PubMedCrossRefGoogle Scholar
  7. 7.
    Crossley GH, Dismukes WE (1990) Central nervous system epidermoid cyst: a probable etiology of Mollaret’s meningitis. Am J Med 89:805–806PubMedCrossRefGoogle Scholar
  8. 8.
    el-Gindi S, Fairburn B (1969) Intramedullary spinal abscess as a complication of a congenital dermal sinus. Case report. J Neurosurg 30:494–497PubMedCrossRefGoogle Scholar
  9. 9.
    French BN (1990) Congenital spinal dermal sinus, Chapter 39. In: Youmans JR (ed) Neurological surgery, vol 2. Saunders, Philadelphia, PA, pp 1176–1182Google Scholar
  10. 10.
    Friede RL (1989) Developmental neuropathology. Springer, Berlin Heidelberg New YorkGoogle Scholar
  11. 11.
    Gupta S, Gupta RK, Gujral RB et al (1993) Signal intensity patterns in intraspinal dermoids and epidermoids on MR imaging. Clin Radiol 48:405–413PubMedCrossRefGoogle Scholar
  12. 12.
    Jindal A, Mahapatra AK (2001) Spinal congenital dermal sinus: an experience of 23 cases over 7 years. Neurol India 49:243–246PubMedGoogle Scholar
  13. 13.
    Maurice-Williams RS, Pamphilon D, Coackham HB (1980) Intramedullary abscess—a rare complication of spinal dysraphysm. J Neurol Neurosurg Psychiatry 43:1045–1048PubMedCrossRefGoogle Scholar
  14. 14.
    Morandi X, Mercier P, Fournier H-M et al (1999) Dermal sinus and intramedullary spinal cord abscess: report of two cases and review of the literature. Child’s Nerv Syst 15:202–207CrossRefGoogle Scholar
  15. 15.
    Tsurubuchi T, Matsumura A, Nakai K et al (2002) Reversible holocord edema associated with intramedullary spinal abscess secondary to an infected dermoid cyst. Pediatr Neurosurg 37:282–286PubMedCrossRefGoogle Scholar
  16. 16.
    Verdu Perez A, Montes Gonzalo MC, Alonso Martin JA (1996) Gram-negative meningitis secondary to congenital dermal sinus demonstrated by magnetic resonance. An Esp Pediatr 44:491–492PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • J. van Aalst
    • 1
    Email author
  • E. A. M. Beuls
    • 1
    • 2
  • E. M. J. Cornips
    • 1
  • L. Vanormelingen
    • 2
  • M. Vandersteen
    • 2
  • J. W. Weber
    • 3
  • J. S. H. Vles
    • 3
  1. 1.Department of NeurosurgeryUniversity Hospital MaastrichtMaastrichtThe Netherlands
  2. 2.Department of Medical Basic SciencesUniversity of HasseltHasseltBelgium
  3. 3.Department of Pediatric NeurologyUniversity Hospital of MaastrichtMaastrichtThe Netherlands

Personalised recommendations