engleski

SPINAL DERMAL SINUS: AN EXPERIENCE OF 16 CASES AND REVIEW

Background. Spinal dermal sinus (SDS), an innocous-apearing form of occult spinal dysraphism can nevertheless produce significant morbidity if not managed in an apropriate fashion. SDS often go unrecognized beacuse of the feeling on the part of the parents of the child or the belief of the physician that only a minor cutaneous problem is present. Patients and methods. Sixteen patients with SDS, with male/female ratio 9/7, aged between two months and 14 years (mean age = 3, 5 years) were operated on in the period 1992 – 2004 in our institution. Results.Lumbosacral region (14 cases) was most frequently involved followed by thoracolumbal region (two cases). The eight patients were asymptomatic at the time of operation (presented only with cutaneous signs). The other eight presented with evidence of spinal compression or tethering. One patient suffered even four bouts of meningitis before the diagnosis of very tiny SDS with intramedullary epidermoid was established. Two patients presented with spinal abscess.MR revealed associated dysraphic state of spinal cord in 14 (88%) patients. All patients underwent microneurosurgical exploration and repair of dysraphic state. Intradural dermal tract extension was found in all cases: terminating on filum 8/16 (50%), on conus 2/16 (14%) and with inclusion tumors 8/16 ( 50%): 5 epidermoids, two dermoids and one teratoma. None of the asymptomatic patients deteriorated. Symptomatic patients improved but the majority with different degree of residual spinal neurological deficit. Conclusion. Natural history of SDS is unfavorable and the current risk of surgical repair low. Therefore all SDS above the intergluteal crease sholud be surgically excised at the time of diagnosis in all patients, regardless of the patient's age or neurological findings.

spinal dermal sinus; spinal dysraphism

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