title: Cranial dermal sinus: presentation, complications and management.
abstract: OBJECTIVE
  Cranial dermal sinus is a very rare anomaly mostly found in the midline occipital area, presenting with diverse clinical features from asymptomatic dermal sinus to symptomatic situations including meningitis, dermoid tumor or abscess.
  
  
  METHODS
  Medical records of 18 patients with 19 cranial dermal sinuses operated at the Children's Hospital Medical Center in Tehran from 1999 to 2011 were retrospectively studied. Their presentations, accompanying anomalies, radiological and surgical findings were evaluated.
  
  
  RESULTS
  Patients were aged 1 month to 6 years and were followed for 2-12 years. Most sinuses were located in the midline occipital region. Infection was the most common reason for referral (50%) followed by skin dimple (33.3%). Creamy white discharge was found in 50% of patients. Posterior fossa abscess, hydrocephalus and meningitis were observed in 38.9, 38.9 and 22.2% of children, respectively. All sinus tracts with associated dermoid tumors or abscesses were removed en bloc to decrease the risk of recurrence.
  
  
  CONCLUSIONS
  The sinus tracts are a portal of entry for pathogens which result in serious complications of meningitis or abscess. In this series, 67% of children presented with serious symptoms; therefore, we recommend prophylactic surgery in all cranial dermal sinuses. The exact time of surgery is not obvious as the natural course of the disease is unknown. If any symptom is observed surgery should be done as soon as possible. For asymptomatic sinuses identified by the pediatrician during a regular visit prophylactic surgery is recommended as soon as the child can tolerate operation.
authors.affiliation: Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14155-7854, Iran.
authors.forename: Soheil
authors.initials: S
authors.lastname: Naderi
authors.forename: Farideh
authors.initials: F
authors.lastname: Nejat
authors.forename: Shima
authors.initials: S
authors.lastname: Shahjouei
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Khashab
mesh_terms: D058070:Asymptomatic Diseases; D001922:Brain Abscess / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003884:Dermoid Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D015192:Infratentorial Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000209:etiology; D009777:Occipital Bone / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D016136:Spina Bifida Occulta / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed