Preparation for Surgery for Dermal Sinus Tracts in Children

Indications for Surgery

• Sinus tract above gluteal fold: The presence of a sinus opening above the gluteal crease warrants prophylactic surgery. A normal spinal MRI does not preclude the decision for surgical exploration, especially in an infant, according to some authors (2, 16).
• Emergent surgery for symptomatic cases: Complicated cases and patients with progressive neurological deficits should be treated in an emergent manner.
• Treat infections first: Surgery is performed on patients with infections only after adequate treatment of the infection.

Preoperative Orders

• Steroids for meningismus: Corticosteroids are used to decrease the edema, usually in cases associated with inclusion tumor or abscess.
• Antibiotics: If there is any clinical or radiological evidence of infection, preoperative antibiotics are advised to control the infection and prevent dissemination of the active purulent material during the procedure.

Anesthetic Considerations

• IOM: No specific consideration except for the time that electrophysiological monitoring is used for surgery.

Devices to Be Implanted

• Equipment for laminotomy: Laminotomy is the preferred way of exposing the spinal canal in children. A powered saw will be needed to perform the laminotomy. The laminar roof will need ot be reattached to the pedicles at the endo f the case so the appropriate materials (suture, metal plates and screws or resorbable plates and pins) for its fixation should be available.
• Dural graft: A dural patch graft from lumbar fascia or other typical sources is advised for a relaxed dural closure.

Ancillary/Specialized Equipment

• Microscope
• IOM equipment