Congenital cranial and spinal dermal sinuses: a report of 3 cases

A Unique Case of Frontotemporal Dermoid Cyst Presenting as Orbital Cellulitis

Dermoid cysts are benign developmental anomalies that can occur anywhere along the neuroaxis or embryonic lines of fusion. While intracranial dermoid cysts at the midline frequently have an associated nasal or subcutaneous sinus tract, it is quite rare to encounter an intracranial dermoid cyst off the midline with a lateral sinus tract. Standard practice for the treatment of dermoid cysts is surgical resection to minimize the risks of meningitis, abscess, mass effect, neurologic deficit, and/or death.  A 3-year-old male with a history of DiGeorge syndrome presented with right orbital cellulitis and a right-sided dermal pit. Computed Tomography (CT) imaging demonstrated a dermal sinus tract with an associated lytic bone lesion within the right sphenoid wing and posterolateral orbital wall with intracranial extension. The patient was taken to the operating room in conjunction with plastic surgery for resection of the dermal sinus tract and intraosseous dermoid.  This case presents a rare occurrence of a non-midline, frontotemporal dermal sinus tract associated with a dermoid cyst with intracranial extension presenting with pre- and post-septal orbital cellulitis. Important considerations include preservation of the frontal branch of the facial nerve, preservation of orbital structure and volume, complete surgical resection to prevent infectious complications including meningitis, and a multidisciplinary surgical approach with plastic surgery, ophthalmology, and/or otolaryngology.

Successful Neonatal, Intraoperative Neuromonitoring in the Surgical Correction of a Thoracic Dermal Sinus Tract: Technical Note

INTRODUCTION

Intraoperative neuromonitoring (IONM) is commonly used during surgery of the spine and spinal cord for early surveillance of iatrogenic injury to the central and peripheral nervous system. However, for infants and young children under 3 years of age, the use of IONM is challenging due to incomplete central and peripheral myelination.

CASE PRESENTATION

We report a case of a T4-T6 dermal sinus tract (DST) that was resected on day of life 23, with the successful use of IONM.

CONCLUSION

To our knowledge, this is the youngest reported case of the use of IONM in the surgical correction of a DST in a neonatal patient. This case demonstrates the potential efficacy of IONM in neonatal spine surgery and the techniques used to adapt the technology to an immature nervous system.

Congenital Spinal Cysts: An Update and Review of the Literature

Congenital spinal cysts are rare and encompass a wide variety of diseases including arachnoid, enterogenous, teratomatous, neurenteric, foregut, bronchogenic, epithelial, ependymal, dermoid, and epidermoid cysts. Here, we elucidate the epidemiology, pathology, pathogenesis, and diagnostic findings of the most common congenital spinal cysts, followed by a discussion of their presentation and treatment options. Differentiating the cause of each lesion is crucial for targeted clinical and surgical management for the patient. Our review describes how arachnoid cysts can be observed, fenestrated, percutaneously drained, or shunted; however, the primary goal for neurenteric, dermoid, and epidermoid cysts is removal. Further, we discuss how patient presentation is dependent on the rate of growth and location of compression on the spinal cord and nerve roots. However, although many of these lesions are discovered incidentally on imaging, the spectrum of possible symptoms include pain, weakness, ataxia, bladder incontinence, and progressive or acute neurologic deficits. We present and review the histology and imaging of a variety of cysts and discuss how although the goal of treatment is resection, the risks of surgery must be considered against the benefits of complete resection in each case.

Congenital Spinal Lipomatous Malformations. Part 1. Spinal Lipomas, Lipomyeloceles, and Lipomyelomeningoceles

Background: Lumbosacral spinal lipomas and lipomyeloceles are usually identified in early childhood. Terminology, histopathology, and diagnosis for these malformations can be confusing. Materials and Methods: This is a PubMed review with comparison of embryology, gross, and histopathology, and reporting requisites for these and related closed spinal malformations. Results: The spinal lipoma group (congenital spinal lipomatous malformations) includes subcutaneous, transdural, intradural, and noncontiguous malformations stretching through the entire lower spinal region. This lipomyelocele trajectory overlaps the embryonic tail's caudal eminence. Histopathologically, the lipomyelocele spectrum is a heterogeneous, stereotypical set of findings encountered from dermis to spinal cord. Diagnosis requires detailed correlation of images, intraoperative inspection, and histopathology. Conclusions: Appropriate terminology and clinicopathologic correlation to arrive at a diagnosis is a critical activity shared by pathologist and clinician. Prognostic and management differences depend on specific diagnoses. Familial and genetic influences play little if any role in patient management in closed spinal malformations.

Central nervous system birth defects in surgically treated infants in Sarajevo region of Bosnia and Herzegovina

Congenital anomalies of the central nervous system (CNS) are common. The prevalence of these anomalies shows considerable geographical variation and female predominance. The aim of this work was to obtain the frequency of different CNS congenital anomalies types and their sex distribution among cases hospitalized in a Department of Neurosurgery, University of Sarajevo Clinics Center, Bosnia and Herzegovina, during the period January 2001 to December 2004. Retrospective study was carried out on the basis of the clinical records. Standard methods of descriptive statistics were performed for the data analysis. A total of 103 cases were surgically treated in the period from 2001 through 2004. Out of that number 56 (54.4%) were female patients, while 47 (46.6%) were male patients. Seven different CNS birth defect types were found in this investigation. These were: spina bifida (42 cases or 40.78%), congenital hydrocephalus (35 cases or 33.98%), arachnoid cyst (15 cases or 14.56%), Dandy-Walker syndrome (5 cases or 4.85%), dermoid cyst (4 cases or 3.88%), one of Arnold-Chiari syndrome (0.98%) and one of encephalocele (0.98%). According to this investigation, CNS congenital birth defects were slightly higher in females (54.4%). The most frequent types were spina bifida (40.78%) both in females (22.33%) and in males (18.45%), hydrocephalus (33.98%) and arachnoid cyst (14.56%). The anomalies of the other organ systems, associated with CNS anomalies obtained in this investigation, were pes equinovarus, cheiloschisis, cardiomegaly and palatoschisis. They were found in six cases (5.82%), equal in both sexes.