{"id":"25160b3d-0fdd-47c0-a1c5-fa5f91a5cf36","slug":"intramedullary-abscess-at-thoracolumbar-region-transmitted-from-infected-dermal-sinus-and-dermoid-through-retained-medullary-cord","title":"Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord","authors":["Yoshie Matsubara","Nobuya Murakami","Ai Kurogi","Sooyoung Lee","Nobutaka Mukae","Takafumi Shimogawa","Tadahisa Shono","Satoshi O. Suzuki","Koji Yoshimoto","Takato Morioka"],"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 (CCLELL), 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.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/25160b3d-0fdd-47c0-a1c5-fa5f91a5cf36/featured/hero-1781561606774.png","publishDate":"2022-02-18T00:00:00.000Z","doi":"10.25259/SNI_1197_2021","categories":["Pediatric Neurosurgery","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/02/11405/SNI-13-54.pdf"}