Dermal Sinus

Dermal sinus is a rare type of congenital occult spinal malformation caused by the incomplete separation of the cutaneous ectoderm and neuroectoderm leading to a fistula. The majority of patients present asymptomatically, but may also present with infections, neurological compromise, CSF leak, urinary symptoms, and foot deformities. It is important to closely scrutinize midline dimples, especially in infants, and to examine patients fully, as they can be the only manifestation. Earlier diagnosis and management are crucial, as they can prevent long-term complications. Thorough physical examination and imaging are the cornerstones of diagnosis. MRI is the diagnostic modality of choice. Surgical management is the recommended treatment, with the goal of complete excision of the tract to prevent recurrence, and to decompress any affected neural structures. Associated meningitis, abscess, hydrocephalus, and other complications should be managed accordingly. Follow up should be regular with physical exam and imaging to check for recurrence. Most patients have a favorable outcome.