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Spinal congenital dermal sinuses: a 30-year experience.
Laurie L Ackerman1, Arnold H Menezes
1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Pediatrics
|September 2, 2003
Summary
Dermal sinus tracts, a form of spinal dysraphism, often present with skin issues but frequently involve neurologic deficits or spinal cord abnormalities. Early surgical evaluation is crucial for preserving neurologic function.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Spinal Dysraphism
Background:
- Dermal sinus tracts are rare congenital anomalies associated with spinal dysraphism.
- They often present in childhood with varied clinical manifestations including skin findings, neurological deficits, and infections.
Purpose of the Study:
- To review surgical outcomes for patients with dermal sinus tracts.
- To analyze presenting symptoms, intraoperative findings, and patient outcomes following surgical intervention.
Main Methods:
- Retrospective analysis of 28 patients who underwent surgical exploration for dermal sinus tracts.
- Data collected included presenting symptomatology, physical examination findings, operative details, and post-operative outcomes.
Main Results:
- 17 female and 11 male patients were identified, with presentations ranging from infancy to adulthood.
- Cutaneous findings were present in 27 patients, while 19 had neurological deficits, more common in older children (>1 year).
- Intraoperative findings included tethered cords (22), inclusion tumors (14), and arachnoiditis (6). Post-operatively, 43% improved, 39% remained neurologically intact, and 11% worsened.
Conclusions:
- Despite referral for cutaneous signs, over half of patients had significant neurological deficits or intradural abnormalities.
- Identification of skin findings warrants prompt radiologic evaluation and neurosurgical intervention.
- Timely surgical exploration and treatment can preserve or improve neurological function in patients with dermal sinus tracts.