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tone, or numbness and paresthesia in the lower sacral  dermatomes.\cite{11956924} Also fluid shifts between the sac and the spinal subarachnoid space can cause intermittent low or high-pressure headache, nausea and vomiting related to changes in body position.\cite{6828997} As a result of this nonspecific symptoms, the diagnosis can be difficult and occasionally it can be confused with other entities.  - confusion con quistes ovaricos y Dx    > The diagnostic studies include plain radiograph, US, myelography, barium enema, CT, excretory urography, and MRI. Imaging studies show a deficient sacrum and a variably sized cyst extending into the pelvis through an enlarged sacral foramen. In order to clarify the diagnosis, continuity of the cyst with the thecal sac must be demonstrated [6,13]. In plain radiographs, the curved appearance of the residual sacrum, scalloped beneath the defect with an appearance of scimitar sacrum, is considered as an almost pathognomonic finding, and is present in 50% of cases [14]. US, as a screening tool, often reveals the presence of the intra-abdominal cystic abnormality. However, before any manipulation such as needle aspiration is performed for the suspected ovarian cyst in Douglas pouch, a plain radiograph must be obtained to look for sacral abnormalities for the patients diagnosed with NF [14]. ASM is seen as a fluid-filled cyst via US and careful examination should be made to avoid misdiagnosis as an ovarian cyst or filled urinary bladder [4]. US may also have a role in the follow up of the size changes in cystic masses. CT is useful to display bony anomalies and erosions and CSF density within the cyst [6]. Intrathecal contrast enhanced CT scanning is the diagnostic procedure of choice, since it not only demonstrates the communication between the meningocele and the subarachnoid space but also usually demonstrates associated tumors if they cause filling defects [13]. However, this method is invasive and has the disadvantage of ionizing radiation. MRI is a safe, rapid, and noninvasive imaging method with multiplanar imaging capability, and it can also show any associated small tumors. Accurate information of the shape, size, anatomical relations to the surrounding organs, and internal characteristic of the cystic mass may be obtained with routine MRI without introduction of contrast material into the spinal canal [13]. MRI is capable of showing characteristic CSF intensity within the cyst, without the need for intrathecal contrast material. MRI can provide nearly all the information derived from CTmyelography, an exception may be demonstration of subarachnoid communication in small-necked lesion [14].  - approaches  > Surgical options consist primarily of either a posterior