gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 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

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Krauß et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.