Rare course of an intraspinal dermoid

Aims: Case report of a six year old boy with dermal sinus, intraspinal dermoid and further development of intraspinal abscess. Intraspinal dermoid is a rare mostly thoracolumbar localized congenital tumor, consisting of included, ectodermal cells with strong association to dermal sinus and intraspinal abscess.

Methods: Presentation of a male newborn with meningitis and fever within an infected dermal sinus in the first month of life. Detection of intraspinal dermoid in lumbar spine in MRI. Extirpation of dermal sinus and partial resection of dermoid. Positive proof of bacteria in histology of dermoid and liquor. Calculated antibiotic therapy over six weeks, subsequently symptom-free and good motoric development over the next five years. Then three relapses over a period of five month with progress of the cystic and substantial parts of the dermoid in MRI. Furthermore development of neurogenic bladder and gut dysfunction and paresis of the femoral nerve. Repeated operative resection of the intraspinal cysts and reduction of dermoid tumor mass. Concomitant intravenous antibiotic therapy over six months. No positive proof of bacteria in repeated analysis. Therefore additional treatment with intravenous dexamethasone and oral tapering in suspicion of sterile meningitis. Continuous improvement of neurological symptoms beneath. Now, independent walking without device is possible, persistent contracture of hip, aconuresis and anal incontinence.

Results: We present a progressive course of an intraspinal dermoid with persistent neurological dysfunction. Differentiation between sterile and bacterial induced meningitis in case of negative findings in microbiological analysis is difficult especially regarding a specific therapy. Despite of interdisciplinary collaboration a long-lasting preservation of motoric function is limited. Here, additional cortisone treatment showed good clinical outcome and improvement of neurological symptoms.

Conclusion: Decision between radical operative strategy with consecutive paraplegia and repeated antibiotic therapies with its complications needs a case-by-case review.

intraspinal dermoid - intraspinal abscess - dermal sinus - meningitis - childhood