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The patient was then referred to our practice, a complete physical examination was made, she mainly complain 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 lower extremities with preservation of tone and 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 sacral defect. The collection measured around 10x9cm, exerting compression on pelvic structures such as the rectum and the bladder in a significant way.  Due to these symptoms and the presence of a growing mass a new surgical procedure consisting in a posterior sacral laminectomy and ligation of the meningocele cyst was proposed. We believe that this approach was appropriate in 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.   The procedure was performed in a prone position, a sacral laminectomy was executed, after exposure of the dural sac, we note that the dura was so thin that it kept tearing continuously, however we proceed with the dissection in order to achieve the greatest possible exposure of the defect, after complete dural exposure the anterior sacral defect lean out, subsequently we pursue with the ligation of the neck, both an anterior and posterior dural patch was placed in order to prevent further leaks of CSF.