Dorsal Dermal Sinus

A Dorsal Dermal Sinus (DDS) is a rare congenital spinal anomaly that results from an incomplete separation of the skin and neural tube during embryonic development. It forms a narrow epithelial-lined tract from the skin surface to deeper layers of the spine, sometimes extending all the way to the spinal cord or meninges. Though externally it may appear like a simple dimple or skin pit, it poses a serious threat of causing central nervous system infections, such as meningitis, abscesses, or even spinal cord tethering, especially in young children. DDS is most often seen in the lumbosacral region, but can occur anywhere along the midline of the back. 🌍 Dorsal Dermal Sinus in Bangladesh: A Hidden Threat In Bangladesh, Dorsal Dermal Sinus is frequently misdiagnosed as a harmless skin pit or dimple, especially in rural areas. Many parents are unaware of its significance until the child develops neurological deficits or life-threatening infections. Due to low awareness and delayed diagnosis, many cases present late with abscesses, progressive limb weakness, or hydrocephalus. Dr. Md. Nafaur Rahman, one of the few dedicated pediatric neurosurgeons in Bangladesh, has successfully treated numerous children with DDS through microsurgical excision and offers complete pre- and post-operative care at NINS and Bangladesh Paediatric Neurocare Centre. 🧬 Causes and Pathogenesis Arises from incomplete disjunction of the skin ectoderm and neural ectoderm during fetal development Often associated with spinal dysraphism such as: Split cord malformation Tethered cord Lipomyelomeningocele Dermoid or epidermoid tumors The sinus tract may end blindly or extend to the dura mater or spinal cord, creating a direct route for infection 🧒 External Signs & Symptoms Early recognition is critical. Look for: Small pit, dimple, or opening along the midline back (especially in upper or lower spine) Hairy patch, skin discoloration, or small skin tag Leakage of pus or clear fluid from the dimple Swelling or redness around the area (suggests infection) Neurological signs: Weakness in legs Abnormal gait Foot deformities Loss of bladder or bowel control In severe cases: spinal cord abscess, meningitis, or hydrocephalus 🔬 Diagnosis of Dorsal Dermal Sinus 🧠 MRI Spine Gold standard imaging Clearly shows the tract, depth, and relation to spinal cord Identifies any associated intraspinal dermoid, epidermoid, or abscess 🧠 MRI Brain (if suspected hydrocephalus or meningitis) 🧪 Blood Tests White blood cell count, CRP for infection Culture of discharge if sinus is draining 🧫 CSF Study If meningitis is suspected 🛠️ Surgical Management Surgical treatment is essential to prevent: Infection (meningitis, abscess) Neurological deterioration Progression to tethered cord syndrome ✂️ Goals of Surgery: Complete excision of the sinus tract Detethering of the spinal cord, if involved Drainage of any abscesses or removal of intradural tumors Prevent retethering or re-infection Surgery is performed under microsurgical techniques to avoid spinal cord injury. Early surgery offers the best long-term outcome. 🔄 Long-Term Follow-Up Children may need periodic neurological and urological assessments Physiotherapy for residual weakness Repeat imaging if any new symptoms develop Most children return to normal activities with no recurrence if treated early 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? Bangladesh’s leading expert in pediatric spinal dysraphism and tethered cord syndromes Successfully operated on numerous cases of dorsal dermal sinus with and without complications Provides complete care at National Institute of Neurosciences & Hospital (NINS) and Bangladesh Paediatric Neurocare Centre Expert in microsurgical excision and intraoperative spinal cord monitoring when needed Dedicated to increasing awareness and access to early diagnosis in rural and urban communities 📞 Schedule a Consultation Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 For Appointment or Referral: 01912988182 | 01607033535 🌐 Visit: www.neurosurgeonnafaur.com