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The anterior transabdominal approach could be performed via laparoscopic or open trans-abdominal/laparotomy, usually it is not considered as the first option unless decompression and rapid removal of the cyst wall is required. Extreme caution must be taken when extensive resection of the cyst wall is performed since adherence to surrounding visceral structures can lead to complications such as fecal or vesical fistulas.\cite{16793455}  Several reports have stressed the advantages of the posterior transsacral technique, since it is considered as a relatively easy and safe technique and is weighted by only a low septic risk. technique.  This approach allows to perform gently ligation of the stalk of the malformation without the need to decompress or remove the cyst, which reduces the risk of posterior  infections. Other advantages obtained with this approach are preservation of the integrity of the nerve roots, spinal cord detethering and, if necessary, reconstruction of any dural defect by microsurgical techniques.