title: Spinal dermal sinuses and dermal sinus-like stalks analysis of 14 cases with suggestions for embryologic mechanisms resulting in dermal sinus-like stalks.
abstract: BACKGROUND
  Spinal dermal sinuses consist of an epithelium-lined tract extending from the skin towards the spinal cord, often resulting in infections or tethered cord syndrome. Recently, a variant called dermal sinus-like stalk was described as an analogous tract but not containing an epithelium-lined lumen.
  
  
  OBJECTIVE
  We aimed to describe the findings in our patients, subdivide our specimens into both conditions, compare the characteristics of both groups and search for possible embryologic mechanisms of dermal sinus-like stalks.
  
  
  METHODS
  We performed a retrospective analysis of all patients operated in our hospital for both conditions between 1996 and 2012.
  
  
  RESULTS
  14 patients were operated upon for spinal dermal sinuses (n = 5) and spinal dermal sinus like-stalks (n = 9). Patients were mainly referred from other hospitals due to skin abnormalities and were evaluated at mean age of 7 weeks and operated upon at mean age of 1 year and 2 months. Primary reason for referral was skin abnormalities in both groups, though there were two cases of meningitis in dermal sinus patients and 2 of recurrent urinary tract infections in dermal sinus-like stalk patients. Consistent with previous findings, dermal sinus-like stalk patients do not have a history of meningitis, lack dermoid or epidermoid tumours along their tract, and are histologically of pure mesodermal origin. Dermal sinus-like stalks might result from interposition of mesenchyme during primary or secondary neurulation.
  
  
  CONCLUSIONS
  We consider dermal sinus-like stalks as a rare but currently under diagnosed condition with different clinical, pathological and probably also embryologic characteristics compared to spinal dermal sinuses.
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: philippe.devloo@uzleuven.be.
authors.forename: P
authors.initials: P
authors.lastname: De Vloo
authors.forename: L
authors.initials: L
authors.lastname: Lagae
authors.forename: R
authors.initials: R
authors.lastname: Sciot
authors.forename: P
authors.initials: P
authors.lastname: Demaerel
authors.forename: J
authors.initials: J
authors.lastname: van Loon
authors.forename: F
authors.initials: F
authors.lastname: Van Calenbergh
mesh_terms: D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012868:Skin Abnormalities / Q000150:complications* / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D014570:Urologic Diseases / Q000150:complications* / Q000601:surgery
keywords: Dermal sinus tract; Dermal sinus-like stalk