Holocord intramedullary abscess due to dermal sinus in a 2-month-old child successfully treated with limited myelotomy and aspiration

Abstract

This 2-month-old child presented with paraplegia. The authors observed a dermal sinus with purulent discharge in the lumbosacral area. Magnetic resonance (MR) imaging of the spine revealed an intramedullary enhancing cavity spanning C-1 to the conus medullaris. Intraoperatively the dermal sinus was seen to infiltrate the lower end of the conus medullaris, and it also communicated directly with the central canal. The L2-5 laminae were removed, and a myelotomy was undertaken on the conus medullaris. A No. 8 French pediatric feeding tube was passed into the abscess cavity and advanced rostrally to the level of C-1. Aspiration was applied via the feeding tube to drain the intramedullary abscess of the spinal cord (IASC). Postoperatively, a 6-week course of intravenous cloxacillin was instituted. Follow-up MR imaging revealed complete resolution of abscess. When the patient was 26 months of age, examination showed complete neurological recovery. The authors describe what, to their knowledge, is the first case of a holocord IASC treated successfully by the aforementioned technique, and review of the related literature.

Brain abscess as a manifestation of spinal dermal sinus

“…Nineteen per cent of patients display evidence of both tumor and infection (Keating et al 2004;Ansari et al 2006). Meningitis and spinal abscess are not uncommon (Matson and Jerva 1966;Bean et al 1979;Bunyaratavej et al 2006).…”

“…Spinal abscess is also an uncommon phenomenon. The source of abscess can be hematogenous or contiguous (including dermal sinuses) (Morandi et al 1999;Bunyaratavej et al 2006). Dermal sinus tracts are common predisposing conditions for spinal abscesses especially in children (Moss et al 1988;Bunyaratavej et al 2006).…”

“…Fever is seen in only half of the patients at the time of diagnosis (Roos and Tyler 2005). Presenting manifestations include signs and symptoms of increased intracranial pressure, decreased level of consciousness, seizure and focal neurological defi cit (including hemiparesis, aphasia) (Roos and Tyler 2005;Bunyaratavej et al 2006;Carpenter et al 2007).…”

“…Lumbar dermal sinuses may give rise to spinal abscesses (Bean et al 1979;Bunyaratavej et al 2006), but there is no documented report of brain abscess as a complication of spinal dermal sinus. Here, we report an 8-month-old girl who presented initially with a brain abscess in early infancy but lumbar dermal sinus and associated spinal abscess were discovered three months later.…”

“…Spinal abscess is also an uncommon infection of the nervous system. It may result from hematogenous bacterial dissemination or local extension of an infected adjacent dermal sinus tract (Morandi et al 1999;Bunyaratavej et al 2006).…”