Congenital dermal sinuses are multilayered tissues that can be found anywhere in the midline between the nasal bone and tailbone. Many cases of intramedullary abscesses have been described in pediatric patients with dermal sinuses that have an intramedullary component [19, 37–47]. A review of dermal sinuses and intramedullary abscess formation has been published elsewhere . The authors of one case report did describe a patient with an epidermoid cyst without a dermal sinus component who eventually developed an intramedullary abscess .