SPINAL DERMAL SINUS
The spinal dermal sinus should always be treated surgically, as it may be the path of local infection that may penetrate into the spinal canal and cause serious disturbances, such as meningitis or abscess. The appearance of a meningeal syndrome in a patient with dermal sinus of the spine, locally infected, represents an immediate indication for surgery. The presence of neurological disturbances is also an indication for surgical treatment that must be performed as early as possible, if these disturbances show progressive deterioration.
SURGICAL TECHNIQUE
The operation is performed as an ordinary laminectomy. A vertical incision is made, that includes the skin changes. During the opening of the spinal canal, a dissection is made of the fibrous tract, which may enter the epidural space and widen into a dermoid or epidermoid (Fig. 16-19). The entire tract, together with the tumour must be removed in one piece. If there are adhesions to the dura or penetration into the dural sac, the latter must be opened and its content well inspected for adhesions between the tract and the meninges, or penetration of the tract itself into the spinal cord, where it widens into a dermoid or epidermoid. These types of tumours are clearly delimited from the spinal cord tissue and are totally removed under optical magnification, with no or little neurological deficit. If the operation is performed after infection has taken place, adhesions may be revealed in the subarachnoid space, which must be divided.