Dermal sinus in children: epidemiology, diagnosis, and management of a retrospective cohort

OBJECTIVE: Dermal sinus (DS) is a rare congenital disorder characterized by an epithelium-lined tract extending inward from the skin, potentially causing severe neurological complications. The current literature is limited by small sample sizes and insufficient analytical depth, hindering clear diagnostic and management guidelines. This is the largest study to comprehensively analyze epidemiological, diagnostic, and management outcomes in order to enhance clinical guidance for pediatric DS. METHODS: The medical records of 107 DS patients (60 males and 46 females; mean ± SD age 2.99 ± 2.67 years) admitted to Beijing Children's Hospital over a 15.62-year period were retrospectively reviewed, with a focus on patient demographic characteristics, clinical presentations, imaging findings, and treatment interventions. Factors associated with clinical outcomes were analyzed using the 2-sided Fisher's exact test (p < 0.05). RESULTS: The mean ± SD prehospital delay was 236 ± 474 days. Infection prevalence was high (80%), primarily meningitis (55%) and myelitis (42%). Neurological deficits were present in 76% of cases. MRI sensitivity was high (94%) for DS tract detection but limited for assessing intradural terminations and inclusion cyst types. The complete resection rate (76%) improved significantly when patients achieved preoperative normalization of body temperature and had sufficient posttherapy waiting periods (> 7 days). Preoperative complications were associated with less favorable outcomes, with 77% of symptomatic patients fully recovering. Recurrence (6%) exclusively followed incomplete resection and was significantly associated with abscesses, hydrocephalus, and shorter posttherapy waiting periods. CONCLUSIONS: Early sign recognition, complementary imaging modalities, careful preoperative management to reduce inflammation, and timely individualized surgical planning balancing neural preservation and recurrence risk are essential for optimizing outcomes in DS.