Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord

Yoshie Matsubara, Nobuya Murakami, Ai Kurogi, Sooyoung Lee, Nobutaka Mukae, Takafumi Shimogawa, Tadahisa Shono, Satoshi O. Suzuki, Koji Yoshimoto, Takato Morioka

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Abstract

Background: A retained medullary cord (RMC) is a relatively newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during secondary neurulation. A congenital dermal sinus (CDS) may provide a pathway for intraspinal infections such as repeated meningitis. Intramedullary abscesses are the rarest but most serious complication of a CDS. Case Description: We treated a female infant with an intramedullary abscess in the thoracolumbar region, which was caused by infection of the CDS. Surgery revealed that the cord-like structure (C-LS) started from the cord with the intramedullary abscess, extended to the dural cul-de-sac, and further continued to the CDS tract and skin dimple. The boundary between the functional cord and the non-functional CL-S was electrophysiologically identified, and the entire length of the C-LS (the RMC) with an infected dermoid cyst was resected. As a result, the abscess cavity was opened and thorough irrigation and drainage of the pus could be performed. Histopathological examination of the C-LS revealed an infected dermoid cyst and abscess cavity with keratin debris in the fibrocollagenous tissue. The abscess cavity had a central canal-like ependymal lined lumen (CC-LELL), with surrounding glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues. Conclusion: We demonstrated that the transmission of an infection through the RMC was involved in the development of the intramedullary abscess. A good postoperative outcome was obtained because a terminal ventriculostomy for pus drainage could be achieved by excising the nonfunctional RMC.

Original languageEnglish
Article number54
JournalSurgical Neurology International
Volume13
DOIs
Publication statusPublished - 2022

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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