Dermal Sinus Tracts of the Spine

Scott Elton, M.D., and W. Jerry Oakes, M.D, Departments of Neurosurgery and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Neurosurg Focus. 2001;10(1) 

In This Article

Abstract and Introduction

Dermal sinus tracts in the spine range from asymptomatic pits to tracts with significant disease. These tracts may be associated with lesions that tether the spinal cord and can either become infected or produce neurological deficits. Over time the treatment of these lesions has varied little: complete resection and intradural exploration are the standard surgical interventions. The authors review their experience with 23 dermal sinus tracts treated in the last 19 years by the senior author. The clinical findings, radiographic appearance, treatment, and pathological findings of these lesions will be discussed. The authors will also provide a summary of the literature covering these lesions.

Dermal sinus tracts are remnants of incomplete neural tube closure. Embryologically, they result from a failure of the surface ectoderm and dermal elements to separate from the neuroectoderm. This process likely occurs between the 3rd and 8th weeks of gestation. Dermal sinus tracts may be associated with spinal fluid drainage, intradural dermoid or epidermoid cysts, and spinal cord tethering. Their treatment in the past has consisted of either superficial resection or intradural surgical exploration. As these lesions often transgress the dura mater and are associated with significant intradural disease, the current literature would support intradural exploration. To further understand dermal sinus tracts, we have reviewed our 19- year experience with the treatment of patients harboring these lesions.