title: Intramedullary dermoid cyst infection mimicking holocord tumor: should radical resection be mandatory?-a case report.
abstract: BACKGROUND
  Dermoid cysts are benign lesions which contain epidermal and dermal elements. Dermoid cysts usually contain a dermal sinus tract but this is not mandatory. Dermoid cysts can manifest by spinal cord infection without a dermal sinus tract. An infected spinal dermoid cyst associated with a holocord spinal abscess poses diagnostic and surgical challenges. Although radical surgical drainage is considered as the main treatment modality for spinal abscess, less extensive surgery for microbiological sampling and appropriate antibiotic treatment can be another alternative modality.
  
  
  METHODS
  A 1-year-old boy patient was admitted to our hospital with progressive paraplegia, bladder dysfunction, and neck rigidity. Medical history of the patient included recurrent urinary tract infection and cephalosporin treatments several times. Initial neurological examination revealed confusion, fever, neck rigidity, paraplegia (also, the motor power of the right upper extremity was three fifths that of the upper extremities). He had urinary and gastrointestinal retention. Conservative surgery was performed to take pathological and microbiological samples. With appropriate antibiotic regimen, the nuchal rigidity and fever improved dramatically. Infectious parameters in blood biochemistry significantly decreased after the antibiotic regimen.
  
  
  CONCLUSIONS
  Holocord spinal abscesses are a rare entity. The source of the disease can be hemopoietic spread or contagious spread. The dermal sinus tract is major risk factor for contagious spread. The major hemopoietic sources are urogenital infection, endocarditis, and infective lung diseases. The hemopoietic spread is a more common source for pediatric patients. The thoracolumbar region is the most common site of involvement. Spinal infection has a tendency to extend longitudinally throughout spinal fibers. The pathogenesis of the holocord edema or syrinx is uncertain. The underlying etiology may be inflammation, infection, and associated venous congestion within the spinal canal. Also, CSF circulation alteration due to arachnoiditis may be another etiological factor. The most important entities on outcome are appropriate surgical treatment and antibiotic administration.
authors.affiliation: Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey. burakkaraaslan08@hotmail.com.|Gazi Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Polikliniği 1. Kat, 06500, Ankara, Turkey. burakkaraaslan08@hotmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Karaaslan
authors.affiliation: Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Göktuğ
authors.initials: G
authors.lastname: Ülkü
authors.affiliation: Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ucar
authors.affiliation: Department of Pediatric Infectious Disease, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Tuğba Bedir
authors.initials: TB
authors.lastname: Demirdağ
authors.affiliation: Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Arda
authors.initials: A
authors.lastname: İnan
authors.affiliation: Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Alp Özgün
authors.initials: AÖ
authors.lastname: Börcek
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D020863:Central Nervous System Cysts / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003884:Dermoid Cyst / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005910:Glioma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D009187:Myelitis / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
keywords: Dermoid cyst; Intramedullary spinal cord abscess; Pediatric neurosurgery; Tetraparesis