Neurological deficits are more likely to occur where diagnosis has not been timely, allowing cysts and or infection. Imaging
Magnetic Resonance Imaging (MRI) is the preferred tool for diagnostic and preoperative imaging of congenital dermal sinus. MRI allows the neural structures to be observed, visualizing the tract and its anomalies and lesions. For example, exposing tethered cord, inclusion tumors or spinal cord malformations. Observation by X-ray is limited in diagnosis, especially due to immature calcification of infants less than 18 months. X-ray may be used in conjunction with MRI or sonogram images to assist preoperatively. Treatment
Treatment of congenital dermal sinus involves complete resection of the tract as well as intradural exploration. Prophylactic surgical removal of the congenital dermal sinus tract is beneficial for the patient, allowing neurological and bladder function to be maintained. Early surgical intervention results decreases the risk of infection and/or tumour progression – factors typically associated with delayed presentation of congenital dermal sinus. ] Intradural exploration is necessary as excision of the entire tract, as well as any of its intradural connections, reduces need for further surgical intervention.The surgical technique involves ‘removing the cutaneous lesion in ellipse’. The tract of the congenital dermal sinus must then be explored and excised, with intradural lesions dissected. If not all epithelial tissue is removed, there is a possibility for the dermoid cyst to reoccur and require further operation. Further operations are limited by postoperative and post-infection scarring.
Congenital dermal sinus may form at any point along the midline of the neuraxis, however, the majority form in the lumbar and lumbosacral region (41% and 35% of cases respectively). Diagnosis
Congenital dermal sinus is often diagnosed in infants and children. Early diagnosis is important in congenital dermal sinus, so that treatment can be provided early, to prevent progression of associated complications. Clinical features
There three key hallmarks of congenital dermal sinus: cutaneous abnormalities, infection, and neurological deficits. Cutaneous abnormalities
Congenital dermal sinus is a tract from the surface layer of the skin, through the deeper tissues into the cranial or spinal cavity. The skin findings of this tract can include:

Pit along neuraxis
Flat capillary hemangioma
Hypertrichosis
Skin tag
Abnormal pigmentation
Subcutaneous lipoma
Signs of local infection

Infection
The stratified squamous epithelium of the congenital dermal sinus tract can extend to the spinal fascia of the dura mater or all the way to the spinal cord. Thus, the congenital dermal sinus forms a point of entry for infection, this can allow for the formation of an abscess, especially among children. Infection can then travel up the spinal cord to result in meningitis, which can be fatal if left untreated. Neurological deficit
Congenital dermal sinus is often also associated with spinal fluid drainage, intradural cysts and spinal cord tethering; conveying neurological deficit. Neurological deficit can occur due to spinal cord compression from intradural dermoid cyst growth in the epidermis and dermis. Tethered spinal cord can result in gait difficulties and sphincter dysfunction, as well as compressing the spine.