case_images: PMC10845342_01
case_images: Mr in case 1 revealed the presence of two tracts (linear arrows) passing from the skin of the right buttock medially toward the lower sacrum (A) the upper DST (B) entered the lower spinal canal through the S3 neural foramen (dotted arrow). There were no radiological signs of intradural extension of the DST.
case_images: fped-12-1346970-g001.jpg
case_images: PMC10845342_01_fped-12-1346970-g001.jpg
case_images: F1
case_images: MR confirmed two DSTs passing through the subcutaneous tissues, with the upper tract terminating at the level of the lower sacrum at the level of the S3 neural foramen (Figure 1).
case_images: PMC10845342_02
case_images: The child in case 2 was followed from birth till the age of 7 years for three lumbar dimples, all located 1 to 2 cm left from the midline. Two of them have been characterized by recurrent discharge and two of them have been partially excised elsewhere. Despite this, no meningitis occurred.
case_images: fped-12-1346970-g002.jpg
case_images: PMC10845342_02_fped-12-1346970-g002.jpg
case_images: F2
case_images: All were paramedian, located at least 1 cm from the midline (Figure 2).
case_images: Mr in case 2 revealed the presence of three DSTs, located at the levels L2, L3 and S1 (A) the conus was located at the level L2. The uppermost DST ended in a subcutaneous dermoid cyst (linear arrow) (B) an intradural inclusion cyst (dotted arrow) was visualized at the level S2 (C).
case_images: fped-12-1346970-g003.jpg
case_images: PMC10845342_02_fped-12-1346970-g003.jpg
case_images: F3
case_images: MRI revealed three DSTs (Figure 3A): one at level L2, ending in a subcutaneous inclusion cyst (Figure 3B), the second at level L3 and the third at level S1. There was no clear intradural extension of the tracts on MR, but an intradural inclusion cyst was recognized at level S2 (Figure 3C).
case_images: Intraoperatively a non-lipomatous filum terminale (linear arrow) (A) was found. The inclusion cyst was tightly attached to the left S2 root (dotted arrow) (B) a complete microsurgical removal was achieved by means of neuromonitoring.
case_images: fped-12-1346970-g004.jpg
case_images: PMC10845342_02_fped-12-1346970-g004.jpg
case_images: F4
case_images: The filum terminale was followed in a caudal direction (Figure 4A) to the level S2, where the epidermoid cyst was found. This was attached to the dorsal aspect of the left S2 root (Figure 4B).