# Cervical Dermal Sinus Tract: A Case Report and Comprehensive Literature Review

## TL;DR

A rare case of a cervical dermal sinus tract in an adult is reported, highlighting the importance of early diagnosis and surgical treatment to prevent complications.

## Contribution

This paper presents a rare adult case of a cervical dermal sinus tract with detailed clinical and imaging findings.

## Key findings

- MRI and CT scans confirmed a dermal sinus tract at C4 with syringomyelia and spina bifida.
- Surgical resection preserved the patient's strength and sensitivity with no residual lesion on follow-up.
- Adult cervical dermal sinus tracts are rare and often lead to delayed diagnosis and complications.

## Abstract

The cervical and thoracic dermal sinuses are rare entities, conforming epithelium-lined tracts that extend from an opening in the skin through a corridor to the layers of the spinal cord. They are commonly detected in early childhood; however, adult reports are singularly rare, especially in cervical regions.

We report a very unusual case of a 45-year-old Mexican female who developed progressive left-side weakness and dexterity suffered from childhood, getting worse in the last year. Physical examination revealed a soft, congenital round cystic lesion in the dorsal-midline skin at the level of C4-C5 vertebrae with no previous treatment received. MRI showed a dermal sinus tract at the C4 level from the skin tethering to the spinal cord and syringomyelia. CT scan showed a dysraphism corresponding to spina bifida at the C4 level and an incomplete closure at the C3 and C5 vertebrae. We surgically managed the lesion by microscopic resection with C3-C5 laminectomy preserving strength and sensitivity. Follow-up MRI showed no residual lesion and contained fistula with no further complications.

Cervical dermal sinus lesions are unusual entities, even less prevalent in adulthood. It represents a possible delay in diagnosis and an increased rate of complications. Early suspicion of the condition is required to make an accurate diagnosis since it is a potentially treatable lesion with a high risk of sequelae without surgical treatment.