Limits...
Prenatal Diagnosis of Congenital Dermal Sinus.

Sakr S, Mohan Y, Malik A, Malik G, Gonik B - AJP Rep (2015)

Bottom Line: Although postdelivery identification in the neonate is aided by several associated physical examination findings, establishing this diagnosis prenatally has proven to be elusive.The associated protrusion of fibrotic membranes through the sinus tract helped in the identification of this lesion prenatally, but created confusion with a more common type of lesion, an open neural tube defect.Conclusion Prenatal diagnosis with postnatal confirmation of CDS leads to early intervention, better long-term outcomes, and lesser complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.

ABSTRACT
Background Congenital dermal sinus (CDS) is an uncommon form of spinal dysraphism. Although postdelivery identification in the neonate is aided by several associated physical examination findings, establishing this diagnosis prenatally has proven to be elusive. Case Report We present a case of CDS where the prenatal findings at 20 weeks gestation led to the diagnosis, which was confirmed postnatally. The associated protrusion of fibrotic membranes through the sinus tract helped in the identification of this lesion prenatally, but created confusion with a more common type of lesion, an open neural tube defect. This is the first case report in the literature describing prenatal diagnosis of fetal CDS. Conclusion Prenatal diagnosis with postnatal confirmation of CDS leads to early intervention, better long-term outcomes, and lesser complications.

No MeSH data available.


Related in: MedlinePlus

Neonatal magnetic resonance imaging of the lumbar spine with radiologic diagnosis of dermal sinus tract, dural tenting, and skin appendage.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4502626&req=5

FI140054-3: Neonatal magnetic resonance imaging of the lumbar spine with radiologic diagnosis of dermal sinus tract, dural tenting, and skin appendage.

Mentions: A 35-year-old female patient, gravida 2, para 1, was referred for consultation following a routine office fetal anatomy scan at 20 weeks' gestation that suggested a neural tube defect (NTD). The patient had a normal first trimester aneuploidy screen and a second trimester maternal serum α-fetoprotein (AFP) level of 0.71 multiples of median. With repeat ultrasound scanning, fetal biometric measurements were consistent with the patient's stated gestational age. The intracranial anatomy was normal, without any abnormalities in the posterior fossa and with normal cerebellar peduncles and normal cerebellar diameters. There was no evidence of ventriculomegaly or associated “lemon” or “banana” signs. In the lower lumbar region of the fetal spine, there appeared to be a thin, free-floating 11 mm finger-like sacculation projecting off the midline portion of one of the lower lumbosacral vertebrae (Fig. 1A, B). Some images also suggested a small skin defect in that area. Genetic amniocentesis was performed and demonstrated a normal karyotype (except for a pericentric inversion of chromosome 9) with a normal amniotic fluid AFP and negative for acetyl cholinesterase. Fetal magnetic resonance imaging (MRI) confirmed the ultrasound findings of normal appearing brain, ventricles, and posterior fossa structures and absence of fetal spine masses, gross segmentation anomalies, obvious NTD or conus abnormality. The soft tissue protrusion in the lumbosacral region was seen, slightly eccentric to the left. The patient was counseled as to the suspected spinal dysraphism diagnosis, with this most likely representing a dermal sinus defect. The patient continued through the pregnancy without complications. She underwent delivery by elective repeat cesarean section at term of an appropriately grown female fetus, with good Apgar scores. At delivery, examination of the neonate was normal except for the identification of a 3 cm translucent skin appendage in the lumbar region (Fig. 2). On day 2, the baby was evaluated by the neurosurgery service. No neurologic deficits were identified. MRI of the spine confirmed the diagnosis of dorsal dermal sinus extending from dural sac, between L4 and L5 and superiorly to the 3 cm skin appendage at the L3 to L4 level (Fig. 3). There was no tethering of the spinal cord and the vertebral bodies were noted to be intact. On the 8th day of life, surgery was performed, including excision of the dermal sinus tract and resection of the meningeal tenting at the level of the dural sac. The skin around the dermal sinus was excised then undermined and using the operating microscope, the sinus was dissected along its margins until the dural sac was reached (Fig. 4). No leakage of cerebrospinal fluid was observed from the dural sac, nor was there any neural tissue in the tract. The tract was closed and flaps were dissected to provide for defect closure. The diagnosis of lumbar dermal sinus tract with associated meningeal tenting was confirmed by the histopathologic examination. Postoperatively, the neonate recovered uneventfully.


Prenatal Diagnosis of Congenital Dermal Sinus.

Sakr S, Mohan Y, Malik A, Malik G, Gonik B - AJP Rep (2015)

Neonatal magnetic resonance imaging of the lumbar spine with radiologic diagnosis of dermal sinus tract, dural tenting, and skin appendage.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502626&req=5

FI140054-3: Neonatal magnetic resonance imaging of the lumbar spine with radiologic diagnosis of dermal sinus tract, dural tenting, and skin appendage.
Mentions: A 35-year-old female patient, gravida 2, para 1, was referred for consultation following a routine office fetal anatomy scan at 20 weeks' gestation that suggested a neural tube defect (NTD). The patient had a normal first trimester aneuploidy screen and a second trimester maternal serum α-fetoprotein (AFP) level of 0.71 multiples of median. With repeat ultrasound scanning, fetal biometric measurements were consistent with the patient's stated gestational age. The intracranial anatomy was normal, without any abnormalities in the posterior fossa and with normal cerebellar peduncles and normal cerebellar diameters. There was no evidence of ventriculomegaly or associated “lemon” or “banana” signs. In the lower lumbar region of the fetal spine, there appeared to be a thin, free-floating 11 mm finger-like sacculation projecting off the midline portion of one of the lower lumbosacral vertebrae (Fig. 1A, B). Some images also suggested a small skin defect in that area. Genetic amniocentesis was performed and demonstrated a normal karyotype (except for a pericentric inversion of chromosome 9) with a normal amniotic fluid AFP and negative for acetyl cholinesterase. Fetal magnetic resonance imaging (MRI) confirmed the ultrasound findings of normal appearing brain, ventricles, and posterior fossa structures and absence of fetal spine masses, gross segmentation anomalies, obvious NTD or conus abnormality. The soft tissue protrusion in the lumbosacral region was seen, slightly eccentric to the left. The patient was counseled as to the suspected spinal dysraphism diagnosis, with this most likely representing a dermal sinus defect. The patient continued through the pregnancy without complications. She underwent delivery by elective repeat cesarean section at term of an appropriately grown female fetus, with good Apgar scores. At delivery, examination of the neonate was normal except for the identification of a 3 cm translucent skin appendage in the lumbar region (Fig. 2). On day 2, the baby was evaluated by the neurosurgery service. No neurologic deficits were identified. MRI of the spine confirmed the diagnosis of dorsal dermal sinus extending from dural sac, between L4 and L5 and superiorly to the 3 cm skin appendage at the L3 to L4 level (Fig. 3). There was no tethering of the spinal cord and the vertebral bodies were noted to be intact. On the 8th day of life, surgery was performed, including excision of the dermal sinus tract and resection of the meningeal tenting at the level of the dural sac. The skin around the dermal sinus was excised then undermined and using the operating microscope, the sinus was dissected along its margins until the dural sac was reached (Fig. 4). No leakage of cerebrospinal fluid was observed from the dural sac, nor was there any neural tissue in the tract. The tract was closed and flaps were dissected to provide for defect closure. The diagnosis of lumbar dermal sinus tract with associated meningeal tenting was confirmed by the histopathologic examination. Postoperatively, the neonate recovered uneventfully.

Bottom Line: Although postdelivery identification in the neonate is aided by several associated physical examination findings, establishing this diagnosis prenatally has proven to be elusive.The associated protrusion of fibrotic membranes through the sinus tract helped in the identification of this lesion prenatally, but created confusion with a more common type of lesion, an open neural tube defect.Conclusion Prenatal diagnosis with postnatal confirmation of CDS leads to early intervention, better long-term outcomes, and lesser complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.

ABSTRACT
Background Congenital dermal sinus (CDS) is an uncommon form of spinal dysraphism. Although postdelivery identification in the neonate is aided by several associated physical examination findings, establishing this diagnosis prenatally has proven to be elusive. Case Report We present a case of CDS where the prenatal findings at 20 weeks gestation led to the diagnosis, which was confirmed postnatally. The associated protrusion of fibrotic membranes through the sinus tract helped in the identification of this lesion prenatally, but created confusion with a more common type of lesion, an open neural tube defect. This is the first case report in the literature describing prenatal diagnosis of fetal CDS. Conclusion Prenatal diagnosis with postnatal confirmation of CDS leads to early intervention, better long-term outcomes, and lesser complications.

No MeSH data available.


Related in: MedlinePlus