American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2018, 6(5), 81-86
DOI: 10.12691/ajmcr-6-5-2
Open AccessCase Report

Occipital Dermal Sinus Tract Causing Craniospinal Infection: Case Report and Review of Literature

Tariq Al-Saadi1, , Ahmed Al Habsi2 and Zahra Al Hajri3

1Neurosurgical Resident, Montreal Neurological Institute and Hospital - McGill University, Montreal, Canada

2Department of Neurosurgery, Khoula Hospital, Muscat, Oman

3Department Radiology, Khoula Hospital, Muscat, Oman

Pub. Date: June 08, 2018

Cite this paper:
Tariq Al-Saadi, Ahmed Al Habsi and Zahra Al Hajri. Occipital Dermal Sinus Tract Causing Craniospinal Infection: Case Report and Review of Literature. American Journal of Medical Case Reports. 2018; 6(5):81-86. doi: 10.12691/ajmcr-6-5-2


Background: Congenital dermal sinus tract (DST) is a rare entity of cranial or spinal dysraphism that may occur anywhere from nasion and along the midline neuraxis from occipital to sacral regions. Craniospinal infection caused by occipital DST is even rarer. Because of their scarcity, these lesions are not well documented in the literature, often mixed with dermal sinuses in other location or other dysmorphic features. This paper reports a unique case of an infant presented with craniospinal abscesses resulting from occipital dermal sinus tract. Methods and materials: In this paper, we report a case of a 16-month-old girl presented with high grade fever, vomiting and lethargy. She had a discharging occipital skin lesion. Her diagnosis was "Occipital DST with Cerebellospinal Abscess", which was treated successfully by excision of the DST and cerebellar abscess. Histopathological examination revealed a dermoid cyst. She received 8 weeks of parenteral antibiotic treatment with a good outcome. Results: Occipital DST is a rare condition. Its clinical presentation varies and clinical suspicion is required. Early neurosurgical intervention is important to prevent the risk of potential complications such as abscess and bacterial meningitis. Conclusion: This case highlights the importance of early recognition and evaluation of midline craniospinal cutaneous stigmata in infant. Further neurosurgical assessment with radiological investigations are recommended for early detection and management. Once diagnosed is made, surgical intervention and appropriate antibiotic therapy are the mainstay of treatment.

occipital dermal sinus tract abscess dermoid meningitis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 3


[1]  Dagcinar A, Kony D, Akakin A, etc. Congenital dermal sinus of the cervical spine in an adult. J Clin Neurosci. 2008 Jan; 15(1): 73-6.
[2]  Kara N. Spinal congenital dermal sinus associated with upper thoracic meningocele. Neurosurg Focus. 2003; 15.
[3]  Karatas Y, Ustun ME. Congenital cervical dermal sinus tract caused tethered cord syndrome in an adult: a case report. Spinal Cord Series and Cases 2015: 15021.
[4]  Wang YM, Chuang MJ, Cheng MH. Infected spinal dermal sinus tract with meningitis: A case report. Acta Neurological Taiwanica 2011; 20: 188-191.
[5]  Groen RJ, van Ouwerkerk WJ. Cerebellar dermoid tumor and occipital meningocele in a monozygotic twin: clues to the embryogenesis of craniospinal dysraphism. Childs Nerv Syst. 1995 Jul; 11(7): 414-7.
[6]  Mann. GS, Gupta.A , Cochrane. DD. and Heran. Occipital Dermoid Cyst Associated with Dermal Sinus and Cerebellar Abscesse.  Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2009:36(4), pp. 487-490.
[7]  Akhaddar A, Jiddane M, Chakir N, El Hassani R, Moustarchid B, Bellakhdar F. Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report. Surg Neurol. 2002 Sep-Oct; 58(3-4): 266-70.
[8]  Afzali N, Malek A, Ghahremani S, Alipour M. Ultrasound Evaluation of Spinal Cord in Newborns with Sacral Pit. Iranian Journal of Neonatology. 2016;7(3).
[9]  Thompson D. Spinal dysraphic anomalies; classification, presentation and management. Paediatric and child health; 2010: 397-403.
[10]  Hung PC, Wang HS, Wu CT, Lui TN, Wong AMC. Spinal intramedullary abscess with an epidermoid secondary to a dermal sinus. Pediatr Neurol 2007; 37: 144-147.
[11]  Higashi S, Takinami K, and Yamashita J. Occipital Dermal Sinus Associated with Dermoid Cyst in the Fourth Ventricle. AJNR. 1995: 16: 945-948.
[12]  Lode HM, Deeg KH and Krauss J. Spinal Sonography in Infants with Cutaneous Birth Markers in the Lumbo-Sacral Region – an Important Sign of Occult Spinal Dysrhaphism and Tethered Cord. Ultraschall in Med 2008; 29: 281-288.
[13]  Lin KL, Wang HS, Chou ML, Lui TN. Sonography for detection of spinal dermal sinus tracts. J Ultrasound Med. 2002 Aug; 21(8): 903-7.
[14]  Soto-Ares G, Vinchon M, Delmaire Ch, etc. Report of Eight Cases of Occipital Dermal Sinus: An Update, and MRI Findings. Neuropediatrics 2001; 32(3): 153-158.
[15]  Mishra S, Panigrahi S. Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst. J Pediatr Neurosci. 2014 Jan-Apr; 9(1): 30-32.
[16]  George F, Donald H.Occipital Dermal Sinus:Clinical and Radiological Findings When a Complete Occipital Dermal Sinus Is Associated with a Dermoid Cyst.AMA Am J Dis Child. 1959; 98(6): 713-719.
[17]  Martin J, Davis L. Intracranial dermoid and epider-moid tumors. Arch Neurol Psychiatry (Chicago) 1943; 49: 56 -70.
[18]  Logue V, Till K. Posterior fossa dermoid cysts with special reference to intracranial infection. J Neurol Neurosurg Psychiatry 1952; 15: 1-12.
[19]  Matson DD, Ingraham FD. Intracranial complications of congenital dermal sinuses. Pediatrics 1951; 8: 463-74.
[20]  Schijman E, Monges J, Cragnaz R. Congenital dermal sinuses, dermoid and epidermoid cysts of the poste- rior fossa. Child’s Nerv Syst 1986; 2: 83-6.
[21]  Rubin G, Scienza R, Pascualin A, Rosa L, DaPian R. Craniocerebral epidermoids and dermoids. Acta Neurochir (Wien) 1989; 97: 1-16.
[22]  Martinez-Lage JF, Capel A, Costa TR, Perez-Espejo MA. The child with a mass over its head: diagnostic and surgical strategies. Childs Nerv Syst 1992; 8: 247-52.
[23]  Goffin J, Plets C, Calenbergh F, et al. Posterior fossa dermoid cyst associated with dermal fistula: report of 2 cases and review of the literature. Child’s Nerv Syst 1993; 9: 179-81.
[24]  Martinez-Lage JF, Ramos J, Puche A, Poza M. Extra- dural dermoid tumours of the posterior fossa. Arch Dis Child 1997; 77: 427-30.