Preparation for Surgery for Dermal Sinus Tracts in Children
Indications for Surgery
Sinus tract above gluteal fold: The presence of a sinus opening above the gluteal crease warrants prophylactic surgery. A normal spinal MRI does not preclude the decision for surgical exploration, especially in an infant, according to some authors (2, 16).
Emergent surgery for symptomatic cases: Complicated cases and patients with progressive neurological deficits should be treated in an emergent manner.
Treat infections first: Surgery is performed on patients with infections only after adequate treatment of the infection.
Steroids for meningismus: Corticosteroids are used to decrease the edema, usually in cases associated with inclusion tumor or abscess.
Antibiotics: If there is any clinical or radiological evidence of infection, preoperative antibiotics are advised to control the infection and prevent dissemination of the active purulent material during the procedure.
IOM: No specific consideration except for the time that electrophysiological monitoring is used for surgery.
Devices to Be Implanted
Equipment for laminotomy: Laminotomy is the preferred way of exposing the spinal canal in children. A powered saw will be needed to perform the laminotomy. The laminar roof will need ot be reattached to the pedicles at the endo f the case so the appropriate materials (suture, metal plates and screws or resorbable plates and pins) for its fixation should be available.
Dural graft: A dural patch graft from lumbar fascia or other typical sources is advised for a relaxed dural closure.