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# Introduction  Anterior sacral meningocele (ASM)is 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.\cite{6470791} It is been reported that erosion of the anterior wall of the sacrum and even sacral fractures could develop into this kind of lesions.\cite{23829288} In approximately 50% of cases, associated malformations are found, which includes spina bifida, spinal dysraphism, imperforated anus, etc.\cite{11353107} Sometimes is associated with syndromes such as Currarino and Marfan syndromes.\cite{24745342} 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.\cite{11956924}\cite{11147856} 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.\cite{16793455} 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.