Occipital Dermal Sinus Tract

A 15-month-old boy was referred for recurrent Escherichia coli meningitis. On examination, he had a small lump (Figure) with a pinhole-sized sinus and tuft of coarse hair (Figure, A, arrow) in the occipital midline area. Computed tomography of the head demonstrated a transosseous tract (Figure, B), and magnetic resonance imaging of the brain showed a lesion between the cerebellar hemispheres (Figure, C). He underwent a suboccipital craniotomy for resection of the dermal sinus tract. The lesion (outlined) was smooth, tan colored, and contained hair when opened (arrow), consistent with a dermoid cyst (Figure, D).

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