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Research article | DOI: https://doi.org/10.31579/2578-8868/226
1 Neurosurgery Department ALI AIT IDIR Hospital Health Establishment, Algiers, Algeria
2 Neurosurgery Department, MUSTAPHA PACHA University Hospital, Algiers, Algeria
*Corresponding Author: F. Bouchenaki, Neurosurgery Department ALI AIT IDIR Hospital Health Establishment, Algiers.
Citation: F. Bouchenaki, N. Habchi, M. Bouallag, K. Boustil, M S. Benachour, S. Bakhti1n. Ioualalen, M.djaafer et all. (2022). The Dermal Sinus: About 29 Cases and Review of the Literature. J. Neuroscience and Neurological Surgery. 11(2); DOI:10.31579/2578-8868/226
Copyright: © 2022 F. Bouchenaki, This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 10 December 2021 | Accepted: 27 December 2021 | Published: 03 January 2022
Keywords: dermal sinus; dysraphism; cutaneous stigmata and complications
The term spina includes several types of congenital malformations including closed spinal dysraphisms, among these 10% are dermal sinuses.Our series includes 29 patients, the majority of which were asymptomatic, but these can present with different clinical pictures including neurological and / or infectious signs indicating a neglected dermal sinus and which therefore requires urgent treatment in the environment. Neurosurgical.MRI confirmed the diagnosis showing the dermal sinus tract communicating from the surface of the skin to the intra-dural space.Once the diagnosis has been made, surgical treatment becomes imperative and urgent because, despite the benignity of the lesion, the majority of which are located in the lumbar region, can lead to formidable neurological sequelae compromising the functional prognosis or even the vital prognosis in some cases.All of our patients were operated on and we obtained 90% good results, however we deplore one case of aggravation and one death.
Dermal sinus is a rare dysraphism that occurs in approximately one in 25,000 births [1-2-3].It is the result of incomplete obliteration of the dermal elements during the closure of the neural tube during embryonic development.They represent 10% of firm spina according to the literature review, the lumbar location is the most frequent [4-2-5].Clinically, the dermal sinus can manifest itself in different forms ranging from the asymptomatic form, especially in newborns or infants, to that including neurological signs associated or not with infectious signs, which is seen in older children.MRI was performed in all of our patients, which confirmed the diagnosis and revealed associated lesions which can be various such as attached lower marrow, dermoid and epidermoid cysts; or abscesses of the ponytail.Despite the mildness of the lesion, the diagnosis must be made in order to avoid the installation of complications that put the functional prognosis into play, leaving definitive neurological sequelae and sometimes life-threatening.
Patients and Methods
This is a retrospective study where we identified 29 patients during a period from January 2014 to July 2020The sex ratio was 16 boys and 13 women.The age varies between 1 month and 15 years which are broken down as follows: 11 patients whose age is less than 1 year; 9 patients between one and four year’s old and 6 patients over four years old. Table 1
The lumbar seat being the most frequent 26 cases (89.65%) followed by 2 in the dorsal region and one case in the cervical region.Clinically, the majority of our patients were asymptomatic in 22 patients (75.86%).4 patients 21% presented with recurrent signs of meningitis, one of which was complicated by the sudden onset of acute paraplegia.Motor disorders are present in 09 cases (31.03%) with a type of peripheral type deficit involving one or more radicular territories concerning one or both lower limbs which may be accompanied by amyotrophy.In addition, 7 patients (24.13%) present sphincter disorders such as urinary incontinence and demonstrated by ultrasounds which show an impact on the urinary systemTransit disorders such as obstinate constipation isolated or accompanying urinary disorders in 04 cases. Table 2
-The orthopedic manifestations of scoliosis and equinovarus feet are only present in 04 cases (13.79%). -Skin stigmata are present in all our patients (100%); sinus ostium associated with a skin pigmentation disorder that may go unnoticed, or has hypertrichosis may be seen.Hypertrichosis with dermal sinusPunctiform dermal sinusCutaneous angiomaInfected dermal sinus
-MRI is the examination of choice and performed in all cases, which has made it possible to highlight the direction and depth of the tract; and any associated lesions [4-6]
The surgical treatment will consist of a laminectomy the aim of the surgery was to completely excise the sinus tract and treat the associated lesions in one stepSurgery was performed in all cases through a midline incision bypassing the sinus.The sinus tract was followed through the subcutaneous tissue and muscle layer to its end and completely excised.After performing the laminectomy, the dura was opened; In cases where the sinus tract was intradural, part of the dura surrounding it was excised.The intraspinal pathologies were treated accordingly, the dermoid cyst and epidermoid were removed; drainage of the abscess, removal of arachnoid adhesions in arachnoiditis and release of the marrow were done in the case of a marrow attached by a thick filum.Patients with infectious complications were managed with appropriate antibiotics according to the results of the antibiogram.
The dermal sinus is a lesion belonging to the closed spina; which represents 10% of closed spina according to the literature reviewIt is the result of the incomplete disjunction between the neuroectoderm and the cutaneous ectoderm its depth can vary from the fascia to the spinal cord, this tract lengthens during growth due to the ascent and can cross several levels in the epidural space before entering the subarachnoid spaces.According to the literature review 60% of the dermal sinuses penetrate into the subarachnoid spaces and 27% are attached to such cauda equina roots and / or to the filum terminale [1-7-8-9].It can also end in extra-dural space in 10% to 20% of cases [4-8].The lumbar seat is the most frequent it varies from 40 to 70
The dermal sinus is a closed spinal dysraphism which is benign in appearance but which can be responsible for debilitating and definitive neurological sequelae in a young patient in the event of neglected dermal sinus; to think about it in front of any recurrent meningitis whether it is septic or not by a careful clinical examination for skin stigmata and to carry out the necessary investigations in order to confirm or not the diagnosis because prophylactic surgery of the dermal sinus is an emergency and not a chimera.
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