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...

Descripción completa

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