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# Conclusions  We present a case of a large anterior sacral meningocele with some interesting nuances. Although the diagnosis sometimes can be very  challenging, the diagnosis should always be kept in mind in order to avoid erroneous diagnoses that may expose the patient to unnecessary surgical procedures. Imaging is critical, but a carefully obtained medical history can reveal important clues. Surgery is generally advised, and multiple especially if there is compression on pelvic structures. Multiples surgical  approaches are available. Each available, although the posterior approach remains the treatment of choice for most lesions, each  approach must be carefully considered and the decision made on the basis of the specific surgical goals, on a case-by-case basis.Usually the posterior approach remains the treatment of choice for most lesions.  Patients with these lesions should be cared for by a multidisciplinary team for further pre and postoperative complete evaluation.