Management problems of Infected Intra-spinal Dermoids

Verma, Saurabh Kumar
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p97
Academic Journal
BACKGROUND: Dermoids are uncommon intradural, extramedullary tumors, usually congenital in nature, rarely associated with a dermal sinus. Only 1% of all spinal tumors are dermoids, which develop during 3rd to 4th week of intrauterine life by the inclusion of ectoderm during the closure of the neural tube. The neoplasms per se present with pain and subtle neurological deficits. Occasional reports describe rare complication of abscess formation with in these dermoids. The presence of dermal sinus leading to an unsuspected serious intradural pathology remains under-estimated. MATERIALS AND METHODS: We present clinico-radiological profile of 19 cases, harboring abscesses with in the dermoids and highlight the importance of dermal sinus, as the notorious stigmata. The present series consists of all pediatric patients harboring 19 intra-spinal abscesses. Emergent exploration, pus drainage and minimal abscesses wall excision tends to decrease the neurological deficits. RESULTS: Prophylactic exploration, radiological investigations may be indicated for all patients harboring a dermal sinus. Pre-operative neurological status provides the best prognosticator of the final outcome. Bowel-bladder control and the cranial nerve deficits resist the improvement even at long-terra follow-up. CONCLUSION: It is the pediatric subgroup of patients who are at risk of developing intramedullary abscesses in association with dermoids. Children usually present with recurrent attacks of meningitis or severe excruciating pain. Severe backache, even without neurological deficits in pediatric patients should be evaluated for cutaneous markers, which if present strongly hint towards inflammatory pathology superimposing over congenital lesions. Contrast enhanced MRI scan should be performed at the earliest. Onset of neurological deficits is a strong poor prognosticator of clinical outcome. Early detection, treatment provides a better outcome, usually eventless, asymptomatic long-term survival. Further, prophylactic surgery may prevent such a devastating complication at all. Poor-socio economic parts of the world may be made aware regarding such an entity as this problem leaves us with more and more of dependent population, especially the children.


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