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Pediatrics
Diagnosis
Spine
Congenital Spinal Malformations
Dorsal Dermal Sinus
Dorsal Dermal Sinus
Usha D. Nagaraj, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Dermal sinus tract (DST), congenital dermal sinus

            • Definitions

              • Sinus tract of subcutaneous tissues lined by stratified squamous epithelium
              • Tract lies above intergluteal cleft & extends deep from skin surface for variable distance
                • Tract may end in subcutaneous tissues, fascia/muscle, vertebrae, epidural space, subarachnoid space, or even intramedullary within spinal cord

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Morioka T et al: Neurosurgical pathology and management of limited dorsal myeloschisis associated with congenital dermal sinus in infancy. Pediatr Neurosurg. 1-13, 2020
                                            2. Majumdar I et al: Dorsal dermal sinus presenting as quadriparesis. BMJ Case Rep. 12(6), 2019
                                            3. Schwartz E et al: Congenital anomalies of the spine. In Barkovich A et al:. Pediatric Neuroimaging. 6th ed. Wolter Kluwers. 987-9, 2019
                                            4. Lee SM et al: Limited dorsal myeloschisis and congenital dermal sinus: comparison of clinical and MR imaging features. AJNR Am J Neuroradiol. 38(1):176-82, 2017
                                            5. Vankipuram S et al: Spinal cord abscess secondary to infected dorsal dermal sinus in an infant: uncommon presentation of a known entity. BMJ Case Rep. 2017
                                            6. Singh I et al: Spinal dorsal dermal sinus tract: an experience of 21 cases. Surg Neurol Int. 6(Suppl 17):S429-34, 2015
                                            7. Tisdall MM et al: Congenital spinal dermal tract: how accurate is clinical and radiological evaluation? J Neurosurg Pediatr. 15(6):651-6, 2015
                                            8. Mete M et al: Congenital dermal sinus tract of the spine: experience of 16 patients. J Child Neurol. 29(10):1277-82, 2014
                                            9. Copp AJ et al: Neural tube defects--disorders of neurulation and related embryonic processes. Wiley Interdiscip Rev Dev Biol. 2(2):213-27, 2013
                                            10. De Vloo P et al: Spinal dermal sinuses and dermal sinus-like stalks analysis of 14 cases with suggestions for embryologic mechanisms resulting in dermal sinus-like stalks. Eur J Paediatr Neurol. 17(6):575-84, 2013
                                            11. Chopra A et al: Spinal congenital dermal sinus presenting as a diagnostic conundrum. Pediatr Neurosurg. 48(3):187-90, 2012
                                            12. Martínez-Lage JF et al: Spinal dermal sinus and pseudo-dermal sinus tracts: two different entities. Childs Nerv Syst. 27(4):609-16, 2011
                                            13. Rufener SL et al: Congenital spine and spinal cord malformations--pictorial review. AJR Am J Roentgenol. 194(3 Suppl):S26-37, 2010
                                            14. Karikari IO et al: Spinal capillary hemangioma in infants: report of two cases and review of the literature. Pediatr Neurosurg. 43(2):125-9, 2007
                                            15. Guggisberg D et al: Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol. 140(9):1109-15, 2004
                                            16. Ackerman LL et al: Spinal congenital dermal sinuses: a 30-year experience. Pediatrics. 112(3 Pt 1):641-7, 2003
                                            17. Elton S et al: Dermal sinus tracts of the spine. Neurosurg Focus. 10(1):e4, 2001
                                            18. Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
                                            19. Weprin BE et al: Coccygeal pits. Pediatrics. 105(5):E69, 2000
                                            20. Chen CY et al: Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess. Pediatr Neurol. 20(2):157-60, 1999
                                            21. Herman TE et al: Intergluteal dorsal dermal sinuses. The role of neonatal spinal sonography. Clin Pediatr (Phila). 32(10):627-8, 1993
                                            22. Barkovich AJ et al: MR evaluation of spinal dermal sinus tracts in children. AJNR Am J Neuroradiol. 12(1):123-9, 1991
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Dermal sinus tract (DST), congenital dermal sinus

                                                      • Definitions

                                                        • Sinus tract of subcutaneous tissues lined by stratified squamous epithelium
                                                        • Tract lies above intergluteal cleft & extends deep from skin surface for variable distance
                                                          • Tract may end in subcutaneous tissues, fascia/muscle, vertebrae, epidural space, subarachnoid space, or even intramedullary within spinal cord

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Morioka T et al: Neurosurgical pathology and management of limited dorsal myeloschisis associated with congenital dermal sinus in infancy. Pediatr Neurosurg. 1-13, 2020
                                                                                      2. Majumdar I et al: Dorsal dermal sinus presenting as quadriparesis. BMJ Case Rep. 12(6), 2019
                                                                                      3. Schwartz E et al: Congenital anomalies of the spine. In Barkovich A et al:. Pediatric Neuroimaging. 6th ed. Wolter Kluwers. 987-9, 2019
                                                                                      4. Lee SM et al: Limited dorsal myeloschisis and congenital dermal sinus: comparison of clinical and MR imaging features. AJNR Am J Neuroradiol. 38(1):176-82, 2017
                                                                                      5. Vankipuram S et al: Spinal cord abscess secondary to infected dorsal dermal sinus in an infant: uncommon presentation of a known entity. BMJ Case Rep. 2017
                                                                                      6. Singh I et al: Spinal dorsal dermal sinus tract: an experience of 21 cases. Surg Neurol Int. 6(Suppl 17):S429-34, 2015
                                                                                      7. Tisdall MM et al: Congenital spinal dermal tract: how accurate is clinical and radiological evaluation? J Neurosurg Pediatr. 15(6):651-6, 2015
                                                                                      8. Mete M et al: Congenital dermal sinus tract of the spine: experience of 16 patients. J Child Neurol. 29(10):1277-82, 2014
                                                                                      9. Copp AJ et al: Neural tube defects--disorders of neurulation and related embryonic processes. Wiley Interdiscip Rev Dev Biol. 2(2):213-27, 2013
                                                                                      10. De Vloo P et al: Spinal dermal sinuses and dermal sinus-like stalks analysis of 14 cases with suggestions for embryologic mechanisms resulting in dermal sinus-like stalks. Eur J Paediatr Neurol. 17(6):575-84, 2013
                                                                                      11. Chopra A et al: Spinal congenital dermal sinus presenting as a diagnostic conundrum. Pediatr Neurosurg. 48(3):187-90, 2012
                                                                                      12. Martínez-Lage JF et al: Spinal dermal sinus and pseudo-dermal sinus tracts: two different entities. Childs Nerv Syst. 27(4):609-16, 2011
                                                                                      13. Rufener SL et al: Congenital spine and spinal cord malformations--pictorial review. AJR Am J Roentgenol. 194(3 Suppl):S26-37, 2010
                                                                                      14. Karikari IO et al: Spinal capillary hemangioma in infants: report of two cases and review of the literature. Pediatr Neurosurg. 43(2):125-9, 2007
                                                                                      15. Guggisberg D et al: Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol. 140(9):1109-15, 2004
                                                                                      16. Ackerman LL et al: Spinal congenital dermal sinuses: a 30-year experience. Pediatrics. 112(3 Pt 1):641-7, 2003
                                                                                      17. Elton S et al: Dermal sinus tracts of the spine. Neurosurg Focus. 10(1):e4, 2001
                                                                                      18. Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
                                                                                      19. Weprin BE et al: Coccygeal pits. Pediatrics. 105(5):E69, 2000
                                                                                      20. Chen CY et al: Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess. Pediatr Neurol. 20(2):157-60, 1999
                                                                                      21. Herman TE et al: Intergluteal dorsal dermal sinuses. The role of neonatal spinal sonography. Clin Pediatr (Phila). 32(10):627-8, 1993
                                                                                      22. Barkovich AJ et al: MR evaluation of spinal dermal sinus tracts in children. AJNR Am J Neuroradiol. 12(1):123-9, 1991