Derm

Cutaneous Signs of Dysraphism

Cutaneous Signs of Dysraphism, Cutaneous Signs of Spinal Dysraphism, Spinal Meningocele Dermatologic Findings, Skin Markers of Spinal Dysraphism

High Risk Findings (Lumbosacral MRI is preferred imaging modality)
1. Midline Lipoma
2. Dermal sinus
  1. Appears as large midline dimple above gluteal crease
  2. Do not probe dimple
Moderate risk findings (Lumbosacral MRI or Ultrasound)
1. Aplasia Cutis Congenita
2. Atypical sacral dimple
3. Gluteal furrow is deviated to one side
Low risk findings (1 present: Consider Ultrasound; 2 present is a high risk finding)
1. Hypertrichosis
2. Midline Hemangioma (e.g. sacral Hemangioma)
3. Mongolian Spot
4. Nevus Simplex
5. Port wine stain
6. Small sacral dimple (normal if within gluteal crease or simple as described below)

Simple sacral dimples do not require additional evaluation
1. Shallow sacral dimple <0.5 cm in diameter AND
2. Within 2.5 cm from anal verge
3. And no hairy patches or Hemangiomas
Further evaluate sacral dimples that do not meet these criteria or other midline defects
1. Atypical dimples >5 mm or >25 mm from anal verge
2. Deep or multiple dimples
3. Dimples superior to gluteal crease, or offset from midline

Lumbosacral Ultrasound for Spinal Dysraphism
1. Indicated in moderate risk findings in age <3 months (see above)
2. Perform by 3 months of age (Vertebral body ossification in older infants obscures the Ultrasound)
3. Typical, but is controversial, as it may not change management
Spinal MRI
1. Indicated in high risk findings or infants age >3 months
2. Consider pediatric neurosurgery Consultation prior to imaging
3. MRI in infants requires sedation