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Cervical dermal sinus complicated with intramedullary abscess in a child: case report and review of literature

Abstract

Background

Dermal sinus tract (DST) is an uncommon spinal dysraphism presenting in childhood along the midline neuroaxis. Cervical DST less frequent is in association with intramedullary abscess.

Methods

A 9-month-old baby was admitted to our unit suffering from right hemiparesis. Physical examination showed a cervical midline cutaneous fistula dripping a yellowish thick liquid. Cervical MRI showed at C5 level a sinus tract in continuity with a C3–C6 intramedullary lesion. Total removal of the fistula and the intramedullary lesion was performed. Histopathological examination confirmed the diagnosis of dermal sinus and abscess.

Results

Post-operative cervical MRI showed a complete removal of the spinal dysraphism, fistula, and intramedullary abscess. The baby showed a progressive clinical improvement and was discharged on day 10 post-surgery.

Conclusion

Literature review confirms that an early diagnosis followed by prompt surgical spinal cord decompression gives a functional neurological recovery.

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References

  1. Ackerman L, Menezes AH (2003) Spinal congenital dermal sinuses: a 30 years experiences. Pediatrics 112(3 pt 1):641–647

    Article  Google Scholar 

  2. Al Barbarawi M, Khriesat W, Qudsien S, Qudsieh H, Loai AA (2009) Management of intramedullary spinal cord abscess: experiences with four cases, pathophysiology and outcome. Eur Spine J 18(5):710–717

    Article  Google Scholar 

  3. Bean JR, Walsh JW, Blacker HM (1979) Cervical dermal sinus and intramedullary spinal cord abscess: case report. Neurosurgery 5 (1 pt1):60–62

    Article  Google Scholar 

  4. Benzil DL, Epstein MH, Knuckey NW (1992) Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Neurosurgery 30(1):118–121

    CAS  PubMed  Article  Google Scholar 

  5. Cardell BS, Bernard L (1951) Congenital dermal sinus associated with meningitis.Br Med J 29;2(4747):1558–1561

    Google Scholar 

  6. Candon E, Frerebeau P (1994) Bacterial abscesses of the spinal cord. Review of the literature (73) cases. Rev Neurol (Paris) 150(5):370–376

    CAS  Google Scholar 

  7. Ceddia A, Di Rocco C, Pastorelli G (1990) The congenital dermal sinus. A clinical case report and review of the literature. Minerva Pediatr 42(12):553–558

    CAS  PubMed  Google Scholar 

  8. Clark SN (1918) Report of a case of spina bifida occulta in the cervical region. J Nerv Ment Dis Sept 48:201

    Article  Google Scholar 

  9. Dagcinar A, Konya D, Akakin A, Gercek A, Ozgen S, Pamir NM (2008) Congenital dermal sinus of the cervical spine in an adult. J Clin Neurosci 15(1):73–76

    PubMed  Article  Google Scholar 

  10. Dogulu F, Onk A, Oztanir N, Ceviker N, Baykaner MK (2003) Cervical dermal sinus with tethered cord and syringomyelia. Case illustration. J Neurosurg 98 (3 Suppl):297

    Google Scholar 

  11. Dubreuilh W (1877) Abcès intramèdullaire consecutive à une tumeur dermoide congenital. Bull Soc Anat Physiol Pathol (Bordeaux) 8:13–26

    Google Scholar 

  12. Favrè C, Lepintre J (1958) Les fistules dermiques congenitales. A propos de l’observation. J Radiol Electrol 39:481–486

    Google Scholar 

  13. French BN (1990) Midline fusion defects and defects of formation. In: Jr Youmans (ed) Neurological Surgery. WB Saunders Company, Philadelphia, PA, pp 1081–1235

    Google Scholar 

  14. Guggisberg D, Hadj-Rabia S, Viney C, Bodemer C, Brunelle F, Zerah M, Pierre-Kahn A, de Prost Y, Hamel-Teillac D (2004) Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol 140(9):1109–1115

    PubMed  Article  Google Scholar 

  15. Hipsley PL (1933) Dermoid cyst of spinal cord. Aust N Z J Surg (2):421

  16. Huang SL, Shi W, Zhang LG (2012) Congenital dermal sinus of the cervical spine: clinical characteristics and management. J Neurosurg Sci 56(1):61–66

    CAS  PubMed  Google Scholar 

  17. Lee JK, Kim JH, Kim JS, Kim TS, Jung S, Kim SH, Kang SS, Lee JH (2001) Cervical dermal sinus associated with dermoid cyst. Childs Nerv Syst 17(8):491–493

    CAS  PubMed  Article  Google Scholar 

  18. Martinez-Lage JF, Esteban JA, Paza M, Cases C (1995) Congenital dermal sinus associated with an abscessed intramedullary epidermoid cyst in a child: case report and review of the literature. Child Nerv Syst 11(5):301–305

    CAS  Article  Google Scholar 

  19. Menezes AH, Graf CJ, Perret GE (1977) Spinal cord abscess: a review. Surg Neurol 8(6):461–467

    CAS  PubMed  Google Scholar 

  20. Mixter WJ (1932) Spinal column and spinal cord. In: Lewis (ed.) Practice of Surgery XII:68

  21. Morandi X, Mercier P, Fournier HD, Brassier G (1999) Dermal sinus and intramedullary spinal cord abscess. Report of two cases and review of the literature. Childs Nerv Syst 15(4):202–206

    CAS  PubMed  Article  Google Scholar 

  22. Nagahiro S, Matsukado Y, Miura M, Yoshioka S (1985) Cervical dermal sinus associated with meningitis and motor paralysis. Brain Dev 7(5):504–507

    CAS  PubMed  Article  Google Scholar 

  23. Peter JC, Sinclair-Smith C, de Villiers JC (1991) Midline dermal sinuses and cyst and their relationship to the central nervous system. Eur J Pediatr Surg 1(2):73–79

    CAS  PubMed  Article  Google Scholar 

  24. Radmanesh F, Nejat F, El Khashab M (2010) Dermal sinus tract of the spine. Child Nerv Syst 26(3):349–357

    Article  Google Scholar 

  25. Ranjan R, Tewari R, Kumar S (2009) Cervical intradural extramedullary ependymal cyst associated with congenital dermal sinus: a case report. Child Nerv Syst 25(9):1121–1124

    Article  Google Scholar 

  26. Sachs E, Horrax G (1949) A cervical and lumbar pilonidal sinus communicating with intraspinal dermoids. J Neurosurg 6:97–112

    PubMed  Article  Google Scholar 

  27. Schiffer J, Till K (1982) Spinal dysraphism in the cervical and dorsal regions in childhood. Child Brain 9:73–84

    CAS  Google Scholar 

  28. Shah RK, Chaljub G, Swischuk LE (2003) Lower cervical dermal sinus tract and associated intraspinal abscess causing meningitis in a child. Emerg Radiol 10(3):160–162

    PubMed  Article  Google Scholar 

  29. Shen WC, Chiou TL, Lin TY (2000) Dermal sinus with dermoid cyst in the upper cervical spine: case note. Neuroradiology 42(1):51–53

    CAS  PubMed  Article  Google Scholar 

  30. Simon JK, Lazareff JA, Diament MJ, Kennedy WA (2003) Intramedullary abscess of the spinal cord in children: a case report and review of the literature. Pediatr Infect Dis J 22(2):186–192

    PubMed  Google Scholar 

  31. Verdu A, De La Cruz M, Castroviejo PI, Villarejo F (1985) Intramedullary dermoid cervical spinal cord in a child (Letters). J Neurol Neurosurg Psych 49:462–463

    Article  Google Scholar 

  32. Wright RL (1971) Congenital dermal sinuses. Prog Neurol Surg 4:175–191

    Google Scholar 

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Correspondence to Zelletta Nicola.

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Nicola, Z., Antonio, C. & De Tommasi, A. Cervical dermal sinus complicated with intramedullary abscess in a child: case report and review of literature. Eur Spine J 23, 192–196 (2014). https://doi.org/10.1007/s00586-013-2930-2

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  • DOI: https://doi.org/10.1007/s00586-013-2930-2

Keywords

  • Dermal sinus
  • Cervical
  • Intramedullary abscess
  • Spinal dysraphism