# Case Report: Two cases of multiples and atypical dermal sinus tracts

## TL;DR

This case report describes two rare instances of multiple and atypically located dermal sinus tracts in children, highlighting the importance of complete surgical removal to prevent infections and neurological issues.

## Contribution

The paper presents two rare clinical cases of multiple and laterally located dermal sinus tracts, contributing to the understanding of their clinical presentation and management.

## Key findings

- Two children presented with multiple and atypically located dermal sinus tracts, including one with bacterial meningitis.
- Complete surgical excision was successfully performed in both cases with good long-term outcomes.
- Multiple or atypically located dermal sinus tracts carry similar infection risks as typical midline tracts.

## Abstract

Dermal sinus tracts (DSTs) are congenital lesions that connect the cutaneous ectoderm with the underlying neuroectodermal tissues. They are typically midline, solitary lesions. Multiple, and atypically located DSTs have been only rarely described. We present two cases of multiple and laterally located DSTs. The first presented with bacterial meningitis and two tracts in the right buttock, one of which entered the spinal canal through the S3 neural foramen. The second child had three midline lumbar DSTs, one subcutaneous dermoid cyst and one intradural epidermoid cyst. Complete surgical excision was achieved in both cases with good late follow up. Multiple or atypically located DSTs appear to carry the same risks of infection as the more common, midline, single tracts. Complete surgical excision is recommended to avoid the risks of neurological deterioration, in particular due to infection. Incomplete disjunction is the proposed developmental anomaly for DSTs, however the location of the cases presented here requires an alternative explanation.