Radiologically occult cervical intradural dermal sinus tract: a case report and review of literature
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CASE REPORT
Radiologically occult cervical intradural dermal sinus tract: a case report and review of literature Takayuki Mukai 1 & Kenichi Usami 1 & Eitaro Ishisaka 1 & Hideki Ogiwara 1 Received: 9 March 2020 / Accepted: 11 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract We report the unusual case of a 7-month-old girl presenting with congenital cervical dermal sinus tract in which the intradural tract was not detected on preoperative imaging and was identified intraoperatively. Considering possible devastating sequelae of infection, excision of dermal sinus tract might be justified even in the case with radiologically undetected intradural tract. Keywords Dermal sinus tract . Intradural tract . Cervical
Introduction
Case report
Congenital spinal dermal sinus tract occurs with an incidence of 1 in 2500 live birth. Of those, cervical dermal sinus tract is rare and accounts for only 1% of all dermal sinus tracts [1–3]. The depth of the tracts varies. When the tract extends into the dura, the risk of infection such as meningitis, subdural abscess, or intramedullary abscess increases [4]. In such cases, surgical excision of dermal sinus tract is recommended to prevent infection even in asymptomatic patients. In cases without an intradural tract, surgical excision may not be recommended due to reduced risk of infections. However, imaging studies may not be relied on detection of an intradural tract, and surgical indication still remains to be established. Herein, we report the unusual case of a 7-month-old girl presenting with congenital cervical dermal sinus tract in which the intradural tract was not detected on preoperative imaging and was identified intraoperatively. Surgical exploration of the intradural tract may better be performed even in radiologically undetected cases.
A 7-month-old girl presented with a cutaneous epithelial defect in the midline of her upper posterior neck. Discharge from the cutaneous defect had not been observed. She had no medical history including meningitis. Physical examination showed no other abnormalities nor neurologic deficit. Magnetic resonance imaging (MRI) demonstrated the subcutaneous tract originating from skin surface to the dura at the level of C1/2, but the intradural tract was unclear (Fig. 1). Since there was possibility that subcutaneous tract penetrated into the dura and would cause subdural infection in the future, we proceeded to the surgical excision of the tract. Combined linear and elliptical skin incision around the cutaneous defect was made. The dermal sinus tract was followed to the level of the fascia. There was a fascial defect around the tract, and the tract entered into the fascia. The fascia was incised, and the tract was further traced deeply. The tract penetrated the dura between the lamina of C1 and C2. C1 laminectomy was performed and elliptical dural incision was made around the tract. Intradurally, the tract was found attached to the spinal cord (Fig. 2). The tract was transected slightly above the cord level. The
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