Dermoids and dermal sinus tracts of the spine.

The evaluation of a child with a midline dimple or pit is one of the most common referrals to a pediatric neurosurgeon. Regardless of their depth, those below the top of the intergluteal crease end blindly and never extend intraspinally. Families can be reassured there is no infection or mechanical risk to the developing nervous system. A high index of suspicion must be maintained for all dimples above the intergluteal fold despite a normal examination or neuroradiologic studies. The midline must be carefully inspected when a child of any age suffers meningitis, especially when an unusual organism is cultured. Conservative management of dermal sinuses is not justified, and these lesions should be electively resected at the time of diagnosis. Dermal sinuses and inclusion tumors may lead to spinal cord tethering and progressive neurologic deterioration. Surgery in advance of deficits maintains normal neurologic function, and children can develop unencumbered by infection, motor, or bladder paralysis.