Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children

G. Lakshmi Prasad, Ajay Hegde, S. Divya

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Introduction Congenital dermal sinuses (CDS) are uncommon lesions. They are most often noted in lumbosacral region and may lead to meningitis or spinal abscess. Intramedullary spinal cord abscess (IMSCA) due to CDS is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst. Materials and Methods Literature review was done to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported. Results Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month-15 years). Fever, acute flaccid lower limb weakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50% of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week-156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60% cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes. Conclusion Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60% cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without.

Original languageEnglish
Pages (from-to)229-238
Number of pages10
JournalEuropean Journal of Pediatric Surgery
Volume29
Issue number3
DOIs
Publication statusPublished - 01-06-2019
Externally publishedYes

Fingerprint

Spina Bifida Occulta
Abscess
Lumbosacral Region
Fever
Cysts
Drainage
Spinal Cord
Extremities
Epidermal Cyst
Dermoid Cyst
Laminectomy
Decompression
Meningitis
Staphylococcus aureus
Lower Extremity
Databases
Pediatrics
Anti-Bacterial Agents
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Prasad, G. Lakshmi ; Hegde, Ajay ; Divya, S. / Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children. In: European Journal of Pediatric Surgery. 2019 ; Vol. 29, No. 3. pp. 229-238.
@article{3aa25b64fb0f49bc9821e735332abc9e,
title = "Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children",
abstract = "Introduction Congenital dermal sinuses (CDS) are uncommon lesions. They are most often noted in lumbosacral region and may lead to meningitis or spinal abscess. Intramedullary spinal cord abscess (IMSCA) due to CDS is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst. Materials and Methods Literature review was done to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported. Results Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month-15 years). Fever, acute flaccid lower limb weakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50{\%} of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week-156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60{\%} cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes. Conclusion Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60{\%} cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without.",
author = "Prasad, {G. Lakshmi} and Ajay Hegde and S. Divya",
year = "2019",
month = "6",
day = "1",
doi = "10.1055/s-0038-1655736",
language = "English",
volume = "29",
pages = "229--238",
journal = "European Journal of Pediatric Surgery",
issn = "0939-7248",
publisher = "Thieme Medical Publishers",
number = "3",

}

Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children. / Prasad, G. Lakshmi; Hegde, Ajay; Divya, S.

In: European Journal of Pediatric Surgery, Vol. 29, No. 3, 01.06.2019, p. 229-238.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children

AU - Prasad, G. Lakshmi

AU - Hegde, Ajay

AU - Divya, S.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Introduction Congenital dermal sinuses (CDS) are uncommon lesions. They are most often noted in lumbosacral region and may lead to meningitis or spinal abscess. Intramedullary spinal cord abscess (IMSCA) due to CDS is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst. Materials and Methods Literature review was done to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported. Results Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month-15 years). Fever, acute flaccid lower limb weakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50% of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week-156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60% cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes. Conclusion Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60% cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without.

AB - Introduction Congenital dermal sinuses (CDS) are uncommon lesions. They are most often noted in lumbosacral region and may lead to meningitis or spinal abscess. Intramedullary spinal cord abscess (IMSCA) due to CDS is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst. Materials and Methods Literature review was done to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported. Results Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month-15 years). Fever, acute flaccid lower limb weakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50% of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week-156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60% cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes. Conclusion Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60% cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without.

UR - http://www.scopus.com/inward/record.url?scp=85047974327&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047974327&partnerID=8YFLogxK

U2 - 10.1055/s-0038-1655736

DO - 10.1055/s-0038-1655736

M3 - Review article

C2 - 29857348

AN - SCOPUS:85047974327

VL - 29

SP - 229

EP - 238

JO - European Journal of Pediatric Surgery

JF - European Journal of Pediatric Surgery

SN - 0939-7248

IS - 3

ER -