Advertisement

Spinal Dermal Sinuses

  • Jonathan Roth
  • Liana Beni-Adani
  • Bo Xiao
  • Liat Ben Sira
  • Shlomi Constantini

Abstract

Dermal sinuses are congenital malformations, representing a subtype of occult spinal dysraphism (OSD). A short historical review presented by [1] cited the first description of dermal sinuses by Ogle in 1865. The first description in English literature was by Verebely in 1913. The incidence of dermal sinuses is frequently noted as 1:2,500 live births [2, 3]. However, this number is based on two studies from 1954 and 1975, both of which were done before the MRI era, and before it was recognized that coccygeal pits and dermal sinus are two distinct entities. Thus, the true incidence is not known [1]. Dermal sinuses are thought to develop in response to an abnormal separation of the cutaneous and the neural ectoderm between the third and fifth weeks of gestation [4, 5, 6]. When this separation fails, a persistent connection, or tract, occurs between the skin and deeper structures. Depending on the degree of incomplete separation, the deeper end of the tract may reach subcutaneous tissue, fascia, dura, or even intradural neural tissue. Another possible underlying mechanism is a defect in notochordal formation with sagittal splitting of the spinal cord and persistence of a cutaneo-endo-mesenchymal fistula.

Keywords

Tethered Cord Dermal Sinus Split Cord Malformation Deep Tissue Injury Occult Spina Bifida 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ackerman LL, Menezes AH, Follett KA (2002) Cervical and thoracic dermal sinus tracts. A case series and review of the literature. Pediatr Neurosurg 3:137–147CrossRefGoogle Scholar
  2. 2.
    Powell KR, Cherry JD, Hougen TJ et al (1975) A prospective search for congenital dermal abnormalities of the craniospinal axis. J Pediatr 5:744–750Google Scholar
  3. 3.
    McIntosh R, Merritt KK, Richards MR et al (1954) The incidence of congenital malformations: a study of 5964 pregnancies. Pediatrics 14:505–522PubMedGoogle Scholar
  4. 4.
    Elton S, Oakes WJ (2001) Dermal sinus tracts of the spine. Neurosurg Focus 1:e4Google Scholar
  5. 5.
    Kanev PM, Park TS (1995) Dermoids and dermal sinus tracts of the spine. Neurosurg Clin N Am 2:359–366Google Scholar
  6. 6.
    French BN (1983) The embryology of spinal dysraph — ism. Clin Neurosurg 295–340Google Scholar
  7. 7.
    Ackerman LL, Menezes AH (2003) Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 3 Pt 1:641–647Google Scholar
  8. 8.
    Caldarelli M, Massimi L, Kondageski C et al (2004) Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg Pediatrics 100(Suppl 5):473–480Google Scholar
  9. 9.
    Morimoto K, Takemoto O, Nishikawa M et al (2002) Nasal dermal sinus with a dermoid cyst. Pediatr Neurosurg 4:218–219CrossRefGoogle Scholar
  10. 10.
    Pang D, Dias MS, Ahab-Barmada M (1992) Split cord malformation: Part I: A unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 3:451–480Google Scholar
  11. 11.
    Swift DM, Carmel PW (1990) Congenital intradural pathology. Neurosurg Clin N Am 3:551–567Google Scholar
  12. 12.
    French BN (1990) Midline fusion defects and defects of formation. In: J Youmans (ed) Neurological surgery. Saunders Company, Philadelphia, pp 1081–1235Google Scholar
  13. 13.
    van Aalst J, Beuls EA, Cornips EM et al (2006) Anatomy and surgery of the infected dermal sinus of the lower spine. Childs Nerv Syst 10:1307–1315CrossRefGoogle Scholar
  14. 14.
    Benzil DL, Epstein MH, Knuckey NW (1992) Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Neurosurgery 1:118–121CrossRefGoogle Scholar
  15. 15.
    Barkovich AJ, Edwards M, Cogen PH (1991) MR evaluation of spinal dermal sinus tracts in children. AJNR Am J Neuroradiol 1:123–129Google Scholar
  16. 16.
    Guggisberg D, Hadj-Rabia S, Viney C et al (2004) Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol 9:1109–1115CrossRefGoogle Scholar
  17. 17.
    Tubbs RS, Frykman PK, Harmon CM et al (2007) An unusual sequelae of an infected persistent dermal sinus tract. Childs Nerv Syst 23:569–571PubMedCrossRefGoogle Scholar
  18. 18.
    Weprin BE, Oakes WJ (2000) Coccygeal pits. Pediatrics 5:E69CrossRefGoogle Scholar
  19. 19.
    Kriss VM, Desai NS (1998) Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography. AJR Am J Roentgenol 6:1687–1692Google Scholar
  20. 20.
    Cornette L, Verpoorten C, Lagae L et al (1998) Closed spinal dysraphism: a review on diagnosis and treatment in infancy. Eur J Paediatr Neurol 4:179–185CrossRefGoogle Scholar
  21. 21.
    Unsinn KM, Geley T, Freund MC et al (2000) US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 4:923–938Google Scholar
  22. 22.
    Medina LS, Crone K, Kuntz KM (2001) Newborns with suspected occult spinal dysraphism: a cost-effectiveness analysis of diagnostic strategies. Pediatrics 6:E101CrossRefGoogle Scholar
  23. 23.
    Pacheco-Jacome E, Ballesteros MC, Jayakar P et al (2003) Occult spinal dysraphism: evidence-based diagnosis and treatment. Neuroimaging Clin N Am 2:327–334, xiiCrossRefGoogle Scholar
  24. 24.
    Kothbauer K, Schmid UD, Seiler RW et al (1994) Intraoperative motor and sensory monitoring of the cauda equina. Neurosurgery 4:702–707; discussion 707Google Scholar
  25. 25.
    Kothbauer KF, Novak K (2004) Intraoperative monitoring for tethered cord surgery: an update. Neurosurg Focus 2:E8Google Scholar
  26. 26.
    von Koch CS, Quinones-Hinojosa A, Gulati M et al (2002) Clinical outcome in children undergoing tethered cord release utilizing intraoperative neurophysiological monitoring. Pediatr Neurosurg 2:81–86CrossRefGoogle Scholar
  27. 27.
    McComb JG (2005) Excision of a spinal congenital dermal sinus/dermoid. In: Fessler RG, Sekhar LN (eds) Atlas of neurosurgical techniques: Spine and peripheral nerves. Thieme, George Verlag, Stuttgart, Germany, pp 715–722Google Scholar
  28. 28.
    Ramnarayan R, Dominic A, Alapatt J et al (2006) Congenital spinal dermal sinuses: poor awareness leads to delayed treatment. Childs Nerv Syst 10:1220–1224CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Jonathan Roth
    • 1
  • Liana Beni-Adani
    • 1
  • Bo Xiao
    • 1
  • Liat Ben Sira
    • 1
  • Shlomi Constantini
    • 1
  1. 1.Department of Pediatric Neurosurgery Dana Children’s HospitalTel-Aviv Sourasky Medical CenterTel-AvivIsrael

Personalised recommendations