Giant anterior sacral meningocele repaired through a posterior approach.
Anterior sacral meningoceles are rare forms of spinal dysraphism produced by herniation of the thecal sac through a bone defect in the anterior sacral wall. The patients may remain asymptomatic or present with nonspecific symptoms such as long-term constipation, urinary dysfunction, lower back pain, or perineal hypoalgesia These lesions are difficult to diagnose without a strong suspicion due to the multiple range of nonspecific symptoms such as low lumbar pain, obstetric problems, and bowel and bladder difficulties. Special care should be taken in order to avoid erroneous diagnoses that may expose the patient to unnecessary surgical procedures. Because these lesions usually do not regress spontaneously, surgical treatment is mandatory for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior transabdominal or posterior transsacral approaches. We present the case of a 82-year-old female patient with a giant anterior sacral meningocele that was initially confused with various entities such as inguinal hernia and an ovarian cyst. Once the anterior sacral meningocele was conffirmed through a MRI-scan she was successfully treated using a posterior transsacral approach. We present a brief review of the current literature and discuss the surgical treatment options.
Keywords: Anterior sacral meningocele, posterior approach, abdominal pain.
Anterior sacral meningoceles (ASM) are a relative rare anomaly of the pre-sacral region, it is defined as a meningeal cyst produced by agenesis of a portion of the anterior sacrum which develops into a herniation of meninges through the defect.(Quigley 1984) It is been reported that erosion of the anterior wall of the sacrum and even sacral fractures could develop into this kind of lesions.(Cools 2013) In approximately 50% of cases, associated malformations are found, which includes spina bifida, spinal dysraphism, imperforated anus, etc.(Dahan 2001) Sometimes is associated with syndromes such as Currarino and Marfan syndromes.(Kole 2014) The presentation of anterior sacral meningoceles can be subtle with very unspecific symptoms, it is for that reason that despite a thorough medical history and physical examination the diagnoses could be challenging. The clinical and radiological features of this condition may vary depending on the patient, although neurological complications are considered uncommon, meningitis, sepsis, obstetric problems, and bowel and bladder difficulties can develop.(Muthukumar 2002)(Hanna 2001) Surgical treatment is the standard for symptomatic or growing masses with compression of adjacent structures. The dural defect can be repaired with a variety of anterior or posterior neurosurgical approaches depending on characteristics of each patient and the features of the cyst.(Ashley 2006) We present a case of a 82-year-old female patient with an anterior sacral meningocele that was successfully treated via an open posterior approach. We discuss the treatment options and a review of the literature.