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The patient was then referred to our practice, a department. A  complete physical and neurological  examination was made, she made. The patient  mainly complain complained  of lower abdominal pain with overflow incontinence, sciatic pain in both legs with a predominance on the left side, and mechanical lower lumbar pain. The neurological examination showed no motor deficits in the at  lower extremities with preservation of tone and reflexes, sensitivity reflexes. Sensitivity  was patchy in both legs around L5 and S1 dermatomes, but resulted quite inconsistent. An MRI (Figure \ref{fig:FIGURE_1}) showed an anterior pre-sacral cyst eroding the anterior wall of S2 and S3, herniating through an anterior  sacral defect. The collection measuredaround  10x9cm, exerting compression onpelvic structures such as  the rectum and the bladder in a significant way. Due to thesesymptoms  pelvic symptoms  and the presence of a growing mass mass,  a new surgical procedure consisting in a posterior sacral laminectomy and ligation of the meningocele cyst was proposed. We believethat  this approach was is  appropriatein order  to get a correct exposure of the cyst neck.Initially, the patient was very unkeen in further surgery, particularly after the results of the previous ones, however, she was so ill that she accepted surgery.