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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Spinal dermal sinus and atretic meningocele – differential diagnosis and treatment

Spinaler Dermalsinus und atretische Meningocele – Differentialdiagnose und Behandlung

Meeting Abstract

  • corresponding author J. Krauß - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • C. Schropp - Pädiatrische Universitätsklinik, Universitätsklinikum Würzburg
  • T. Schweitzer - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • H. Collmann - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg
  • N. Sörensen - Abteilung für Pädiatrische Neurochirurgie der Neurochirurgischen Universitätsklinik, Würzburg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.05.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc072.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Krauß et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Recognition of dermal sinus and atretic meningocele as well as differentiation between these entities and the common and harmless coccygeal sinus continue to pose problems for many clinicians potentially resulting in either delay of urgent treatment or unnecessary surgery for harmless blemishes. This study aims to clarify the specific signs of each of these entities and to outline treatment regimen and results.

Methods: Retrospective analysis of all cases of spinal dermal sinus and atretic meningocele operated upon since 1979. Presentation of cutaneous signs with differential diagnosis.

Results: A series of 74 children consecutively treated is reported. A dermal sinus was found in 50 cases, an atretic meningocele in 24 cases. Of the dermal sinus cases, 15 infants were treated during the first year of life. Of those, only 4 had a history of meningitis, whereas 23 of 35 older children had suffered meningitis episodes. Local inflammation or fluid excretion was not a reliable predictor of CNS infection. No imaging modality reliably depicted the involvement of the intradural compartment. MRI yielded false negative results in one third of the cases. Surgery revealed intradural extension of the malformation in 45 patients with inclusion tumors in 27 cases. 21 patients had newly developed or progressive symptoms preoperatively, 16 due to infection. All preoperatively asymptomatic patients remained so after surgery. All patients with symptoms not related to infection recovered completely. Of 16 patients with postmeningitic deficits and adequate follow-up, however, only 7 have become asymptomatic. All but 2 of the atretic meningocele cases were treated within the first 2 years of life. The infants were treated prophylactically, symptoms when present could be attributed to sacral dysgenesis or syringomyelia. The two older patients presented with tethered cord symptoms. No patient with atretic meningocele developed infection.

Conclusions: Clinical examination in the newborn period allows for safe differentiation between these entities. Unnecessary operations on coccygeal sinuses can be avoided and prophylactic surgery without urgency is recommended for atretic meningocele. Complete excision of a dermal sinus should be scheduled during the first weeks of life as the only safe strategy to prevent morbidity from this malformation.