Top

European Spine Journal

Published in:

01-05-2014 | Case Report

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

Authors: Zelletta Nicola, Calace Antonio, Antonio De Tommasi

Published in: European Spine Journal | Special Issue 2/2014

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.

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

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):710–717CrossRef

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

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

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

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

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):553–558PubMed

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

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):73–76PubMedCrossRef

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

11.

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

12.

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

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

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):1109–1115PubMedCrossRef

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):61–66PubMed

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):491–493PubMedCrossRef

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):301–305CrossRef

19.

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

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):202–206PubMedCrossRef

22.

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

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):73–79PubMedCrossRef

24.

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

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):1121–1124CrossRef

26.

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

27.

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

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):160–162PubMedCrossRef

29.

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

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):186–192PubMed

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 49:462–463CrossRef

32.

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

Title: Cervical dermal sinus complicated with intramedullary abscess in a child: case report and review of literature
Authors: Zelletta Nicola
Calace Antonio
Antonio De Tommasi
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 2/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-2930-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Special Issue 2/2014

Low back pain tied to spinal endometriosis

A case of vertebral artery duplication at the level of atlas: anatomical description

Cervical spondylosis: a rare and curable cause of vertebrobasilar insufficiency

Combined traumatic atlantooccipital and atlantoaxial articulation instability: a case report with survival

Multifocal spinal malignant peripheral nerve sheath tumor in an immunocompromised individual: case report and review of literature

Analysis of a β-TCP bone graft extender explanted during revision surgery after 28 months in vivo