Spinal congenital dermal sinuses: a 30-year experience

Laurie L Ackerman; Arnold H Menezes

doi:10.1542/peds.112.3.641

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Spinal congenital dermal sinuses: a 30-year experience

Journal article

Peer reviewed

Spinal congenital dermal sinuses: a 30-year experience

Laurie L Ackerman and Arnold H Menezes

Pediatrics (Evanston), Vol.112(3 Pt 1), pp.641-647

09/2003

DOI: 10.1542/peds.112.3.641

PMID: 12949296

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Abstract

Dermal sinus tracts are an uncommon form of spinal dysraphism often presenting in childhood with skin findings, neurologic deficit, or infection. We reviewed our surgical experience, examining presenting symptomatology, operative findings, and patient outcomes. A retrospective analysis of operated dermal sinus tract cases by the senior author (A.H.M.) from 1970 to present was made. Twenty-eight patients were identified; 17 female and 11 male. Five cervical, 4 thoracic, 9 lumbar, and 9 lumbosacral tracts were explored. Sixteen patients presented at <1 year of age, and 12 were >1 year. Reasons for referral included cutaneous findings (15), neurologic deficit (8), foot abnormalities (4), infection (3), pain (2), and scoliosis (1). Our initial examination revealed cutaneous findings (eg, sinus ostea, pigmentation changes, erythema, skin tags, subcutaneous masses) in 27 patients and neurologic deficit in 19. Age-related differences were apparent. Patients >1 year were more likely to have neurologic deficit (92%) as compared with those <1 year (50%). Bifid spinous processes were noted at dural tract entry in 17 patients. Twenty-two tethered cords, 14 inclusion tumors, and 6 patients with evidence of arachnoiditis were found intraoperatively. Mean follow-up was 33 months. Eleven (39%) remained neurologically intact, 12 (43%) improved, 2 (7%) were unchanged, and 3 (11%) were worse with 2 having decreased perianal sensation and 1 slightly worsened motor function postoperatively. Although most patients were referred for cutaneous stigmata evaluation, >50% had neurologic deficit, intradural tumors, or tethered cords. Skin findings identification should initiate prompt radiologic evaluation and neurosurgical intervention with intradural exploration. Timely intervention may preserve or improve neurologic function in these patients.

Spinal Cord - abnormalities

Follow-Up Studies

Humans

Middle Aged

Child, Preschool

Spina Bifida Occulta - diagnostic imaging

Infant

Male

Meningitis - diagnostic imaging

Spinal Cord Neoplasms - diagnostic imaging

Back Pain - surgery

Spinal Dysraphism - diagnosis

Spina Bifida Occulta - surgery

Meningitis - diagnosis

Spinal Cord Neoplasms - surgery

Adult

Female

Retrospective Studies

Child

Infant, Newborn

Back Pain - etiology

Spinal Cord - diagnostic imaging

Spina Bifida Occulta - diagnosis

Treatment Outcome

Spinal Cord - surgery

Radiography

Adolescent

Spinal Cord Neoplasms - diagnosis

Referral and Consultation

Spinal Dysraphism - diagnostic imaging

Spinal Dysraphism - surgery

Details

Title: Subtitle: Spinal congenital dermal sinuses: a 30-year experience
Creators: Laurie L Ackerman - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA
Arnold H Menezes
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.112(3 Pt 1), pp.641-647
DOI: 10.1542/peds.112.3.641
PMID: 12949296
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics; United States
Language: English
Date published: 09/2003
Academic Unit: Stead Family Department of Pediatrics; Neurosurgery; Otolaryngology
Record Identifier: 9984040329402771

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111 Times Cited - Web of Science

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