Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy.

  • Walker, A. Earl (Arthur Earl), 1907-1995.
Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy. Source: Wellcome Collection.

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    dura, about H cm. above the spinal cord, giving way to a mass of fibrous tissue. Beginning immediately below the lower and defective end of the epithelial tube, this fibrous mass becomes densely infiltrated with inflammatory cells, small round cells, plasma cells, macrophages and an occasional polymor¬ phonuclear leucocyte. The dense connective tissue mass is composed largely of thick fibres of collagen, a few fine fibres of reticulin and a few fibroblasts. In many places within this thick felt-work of connective tissue small abscesses are seen containing cells similar to those noted above, and many multinucleated giant cells of the “foreign-body” type. No bacteria were seen in these abscesses and it will be recalled that no organisms could be cultivated from this purulent material. Nowhere is any nervous tissue seen. Dr. George W. Barthelmez, of our Department of Anatomy, very kindly examined sections of this malformation. He was of the opinion that the histological appearance of the skin in the sinus with a narrow malpighian layer and no papillae was embryonic in character and resembled that on the dorsal side of the finger tip in a four months’ foetus. He considered that the small epithelial proliferations from the skin of the sinus near its base were primordia of sebaceous glands, and comparable to findings in embryonic skin. In brief, the pathological picture is that of an epithelial tube extending from the skin through unfused spinal laminae to an inflammatory mass composed of numerous small sterile abscesses lying beneath a thickened dura, involving the arachnoid and attached to the posterior surface of the spinal cord. In this case of spina bifida, instead of the usual type of developmental abnormality in which a “ firm fibrous band of connective tissue, fat, elastic tissue and striated muscular fibres passes through the vertebral cleft and connects the cord with the overlying skin” (Frazier |_2]), the cord was connected by an epithelial tube passing through the defect in the lamina to the skin on the surface of the body. This congenital malformation is identical with the pilonidal sinuses which occur in the sacral and coccygeal regions. The name pilonidal is a misnomer since only 40 per cent, of those sinuses contain hair (Owen [6]). For that reason we have called these malformations congenital dermal sinuses as we believe this more accurately describes the anatomico-pathological condition. Histologically, however, there is no distinction between the two anomalies. With an understanding of the pathology of the case it is easy to explain the pathogenesis of the patient’s earlier illness, diagnosed as tuberculous meningitis, from which she recovered. In the course of time infectious material undoubtedly found its way into the epithelial tube through the open stoma which appeared as an inoffensive dimple on the surface. This set up an inflammatory reaction within the tube