Occipital Dermal Sinus: The Tip of the Iceberg

A 2-year-old girl presented with a congenital occipital lump centered by a tuft of coarse hair with a small orifice (Figure, A); this had grown and developed a purulent flow over 1 year. She had no neurologic symptoms and no history of fever. Her general practitioner prescribed topical antiseptic and antibiotic, but the lump recurred. An ultrasound scan revealed a subcutaneous fistulous tract communicating with a deeper mass lysing the occipital bone. Computed tomography and magnetic resonance imaging scans documented a dermal sinus connected to an intradiploic occipital dermoid cyst (Figure, B-E).The full lesion was resected through a suboccipital approach.

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