Dermal Sinus Tracts in Children Homepage

Author

Farideh Nejat, M.D.

Section Editors

Bermans J. Iskandar, M.D.

Graham Fieggen, M.D.

Senior Editor

Ann Ritter, M.D.

Editor In Chief

Rick Abbott, M.D.

Introduction

Spinal dermal sinus tracts are abnormal connections between skin and spinal cord that cause cord tethering. They are considered as part of the spectrum of spina bifida occulta. Despite the frequent presence of cutaneous stigmata, these lesions are often diagnosed late or not at all. In some circumstances, the diagnosis is made after repeated bouts of meningitis. Because of the risk of meningitis, it is imperative that primary health care givers be made aware of this important entity to promote early diagnosis.

Key Points

• One in 2500 births: Spinal dermal sinus openings and tracts occur in approximately one in every 2,500 live births (1). Dermal sinuses include a tract lined by epithelial cells and travel through the underlying structures for variable depths, usually terminating in the thecal sac (2).
• Usually neurologically normal at birth: Most patients with dermal sinus tracts are neurologically normal at birth, but many become symptomatic later if the lesion is left uncorrected. Spinal cord tethering may cause neurological deterioration. Alternatively, a sinus tract open to the skin may cause a meningitis or abscess (11, 16).
• Increasing risk of deficits with aging: The risks of neurological deficits and/or infectious complications from dermal sinus tracts are higher at older ages (2, 9, 16), which highlights the importance of timely diagnosis and treatment.
• Frequently associated with other anomalies: As one of the spinal bifida occulta lesions, dermal sinus tracts are often associated with other spinal anomalies such as inclusion tumors and split cord malformations (16).