Cargando…
Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord
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...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888283/ https://www.ncbi.nlm.nih.gov/pubmed/35242420 http://dx.doi.org/10.25259/SNI_1197_2021 |
_version_ | 1784661114787725312 |
---|---|
author | Matsubara, Yoshie Murakami, Nobuya Kurogi, Ai Lee, Sooyoung Mukae, Nobutaka Shimogawa, Takafumi Shono, Tadahisa Suzuki, Satoshi O. Yoshimoto, Koji Morioka, Takato |
author_facet | Matsubara, Yoshie Murakami, Nobuya Kurogi, Ai Lee, Sooyoung Mukae, Nobutaka Shimogawa, Takafumi Shono, Tadahisa Suzuki, Satoshi O. Yoshimoto, Koji Morioka, Takato |
author_sort | Matsubara, Yoshie |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8888283 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-88882832022-03-02 Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord Matsubara, Yoshie Murakami, Nobuya Kurogi, Ai Lee, Sooyoung Mukae, Nobutaka Shimogawa, Takafumi Shono, Tadahisa Suzuki, Satoshi O. Yoshimoto, Koji Morioka, Takato Surg Neurol Int Case Report 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. Scientific Scholar 2022-02-18 /pmc/articles/PMC8888283/ /pubmed/35242420 http://dx.doi.org/10.25259/SNI_1197_2021 Text en Copyright: © 2022 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Case Report Matsubara, Yoshie Murakami, Nobuya Kurogi, Ai Lee, Sooyoung Mukae, Nobutaka Shimogawa, Takafumi Shono, Tadahisa Suzuki, Satoshi O. Yoshimoto, Koji Morioka, Takato 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 |
title_full | Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord |
title_fullStr | Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord |
title_full_unstemmed | Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord |
title_short | Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord |
title_sort | intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888283/ https://www.ncbi.nlm.nih.gov/pubmed/35242420 http://dx.doi.org/10.25259/SNI_1197_2021 |
work_keys_str_mv | AT matsubarayoshie intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT murakaminobuya intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT kurogiai intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT leesooyoung intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT mukaenobutaka intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT shimogawatakafumi intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT shonotadahisa intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT suzukisatoshio intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT yoshimotokoji intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord AT moriokatakato intramedullaryabscessatthoracolumbarregiontransmittedfrominfecteddermalsinusanddermoidthroughretainedmedullarycord |