Sacral Meningocele Research Articles

Prenatal diagnosis of anterior sacral meningocele

Anterior sacral meningocele is an extremely rare condition and there has been only one previous report of a prenatal diagnosis. We report the case of a 36-year-old primigravida who was referred following detection of a huge fetal pelvic cyst on routine ultrasound examination at 19 + 4 weeks' gestation. Neither fetal ultrasound nor magnetic resonance imaging (MRI) at 20 + 5 weeks' gestation could detect communication between the cyst and the spinal cord. Because extension of the pear-shaped cyst through the pelvic diaphragm down to the perineum was reminiscent of dilated vagina and uterine cervix, a tentative diagnosis of hydrometrocolpos secondary to imperforate hymen was considered. On follow-up MRI at 33 + 5 weeks' gestation, a narrow stalk connecting the pelvic cyst and the spinal canal through the anterior sacral foramen was clearly delineated, allowing us to reach the prenatal diagnosis of anterior sacral meningocele.

Anterior sacral meningocele presenting as constipation

Anterior sacral meningocele (ASM) is a rare form of spinal dysraphism in children. Usually asymptomatic, it can present as constipation, urinary problems or rarely neurological symptoms. High index of suspicion with careful clinical examination is necessary to make early diagnosis. Magnetic resonance imaging is the investigation of choice. We describe a successfully managed young child with ASM associated with rib and vertebral defects.

Epidermoid cyst inside anterior sacral meningocele in an adult patient of currarino syndrome manifesting with meningitis

The Currarino triad, also known as the "Currarino Syndrome", is a rare complex of congenital caudal anomalies including three main features; a sacral bony deformity, anorectal malformations, and a presacral mass. We present an extremely uncommon case of Currarino syndrome in adulthood presenting with repeated episodes of meningitis. Magnetic resonance imaging of spine was suggestive of caudal regression. Cord was low lying, conus ending at L3 level with evidence of tethering at that level. A large cyst was noted in the sacral canal extending forwards in the pelvis through the widened sacral foramina on right side. She was operated through a posterior approach, via sacral laminectomy. Dura was opened in the midline, large silvery white epidermoid tumor was found completely occupying the anterior sacral meningocele. The case and relevant literature is discussed.

Meningocele sacro anterior oculto

The anterior sacral meningocele is a rare form of spinal dysraphism located in the presacral extraperitoneal space. It is generally asymptomatic and appears as a small pelvic mass. We present a case of a 10 year-old male that develops a bacteria meningitis because of a pararectal abscess that is connected with an anterior sacral meningocele. We successfully treated it using a posterior approach. The aim of the surgery is to repair the dural defect and to obliterate the communication between the thecal sac and the herniation defect. The posterior approach is the simplest and most effective surgical technique because the lower risk of neurological injury than the anterior approach.

A 40-Year-Old Woman With Cauda Equina Syndrome Caused by Rectothecal Fistula Arising From an Anterior Sacral Meningocele

We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome. The patient was a 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue. We discuss the characteristics, management, and evolution of this unusual case. Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome.

OC12.03: Visualization of the fourth ventricle in first trimester fetuses with a normal spine versus spina bifida

Non-visualization of the fourth ventricle in the first trimester of pregnancy has been suggested as a possible marker for open neural tube defects. We evaluated the utility of this marker in our population. Retrospective analysis of digitally stored facial mid-sagittal images acquired during nuchal translucency screening between 11 + 0 and 13 + 6 weeks gestation. Images of 3 cases of spina bifida were randomly interspersed among 200 normal cases, and three blinded examiners determined presence of fourth ventricle, and if visible, measured ventricular size in the antero-posterior diameter. False-negative and false-positive cases were subsequently reviewed by two additional reviewers to determine if image quality affected diagnostic accuracy. The fourth ventricle was not observed in 11/600 image examinations (1.8%; negative predictive value 0.99) of normal fetuses, and was falsely determined to be present in 5/9 examinations of spina bifida cases. However, this included one case with a distal sacral meningocele, which did not display intracranial manifestations of cord tethering in the first or second trimester. Fourth ventricle size increased with gestational age (P < 0.0001), and measurement variability was smaller in the last 100 cases, in comparison to the first 100 cases (P = 0.007). In 2 examinations of spina bifida cases with a seemingly identifiable intracranial translucency, the fourth ventricle size was below the 5th percentile of the normal reference range. Review of false positive and negative cases revealed inappropriate image acquisition or caliper placement in 9 of 16 cases. Our data confirm that lumbosacral, but not distal sacral, spina bifida is associated with an unidentifiable fourth ventricle in the first trimester midsagital view of the brain. However, the correlation is smaller than previously reported, and a small fourth ventricle size is also suggestive of spina bifida.

Amniotic band syndrome associated with sacral meningocele and anal atresia

Amniotic band syndrome associated with sacral meningocele and anal atresia

Lateral sacral meningocele presenting as a gluteal mass: a case report

IntroductionLateral meningocele is a very rare disorder. It has been reported in patients with neurofibromatosis or Marfan's syndrome. Previous reports have described lateral meningoceles in the thoracic or cervical region. Lateral meningocele in the sacral area was reported in the literature only once.Case presentationWe describe a 3.5-year-old Iranian girl who presented with a lateral gluteal mass. Neuroimaging and intra-operative evaluation showed that the mass was a lateral sacral meningocele with spinal communication through the iliac bone. We also present a review of the literature about this entity.ConclusionsAlthough lateral meningoceles especially in the sacral region are rare disorders, their possibility should always be considered in young patients presenting with a paravertebral or gluteal mass.

Sacral Meningocele in a Military Pilot, Presenting During Flight

This study describes an unusual case of a military pilot with sacral meningocele that contained cerebrospinal fluid and presented as episodes of gluteal neuralgia during flight. The patient, a 38-yr-old male pilot, had complained of a dull and mild low lumbar pain over the previous 10 mo. These pains were exacerbated and radiated to the left gluteal region during flight. The patient's history, clinical examination, imaging findings, and treatment are reported. CT and MRI imaging revealed an unusual case of sacral meningocele (2.2 cm x 3.6 cm X 5.8 cm). These lesions can progress steadily in size, leading to worsening symptoms and potentially requiring surgical management. However, surgery is not indicated for stable and asymptomatic lesions not associated with tumors. In our case, tactical monitoring was suggested, since no other symptoms appeared. There are currently no other reported cases involving pilots, so an individual approach to treatment should be taken in accordance with their military health service, the potential, risk factors, and depending on the level of acceleration experienced. We discuss the pathogenesis, the clinical and radiological findings of this rare condition, and note that a spinal cyst is of special interest when occurring in pilots since they are exposed to intense accelerations and spinal strain.

Conception in an infertile patient following obliteration of a huge anterior sacral meningocele: case report

We present the case of a 35-year-old woman with a large anterior sacral meningocele who had been unable to conceive. Following neurosurgical consultation, she underwent repair of her meningocele which resulted in complete resolution of her meningocele and 1 year later, she delivered her first child. This case demonstrates that following surgical treatment, female patients with anterior sacral meningoceles may be able to conceive and bear children.

Currarino's syndrome misinterpreted as Hirschsprung's disease for 17 years: a case report

BackgroundCurrarino's syndrome is an autosomal dominant hereditary disease known by the triad of anorectal stenosis, anterior sacral defect, and a presacral mass that is most often an anterior sacral meningocele. Actually this syndrome could remain asymptomatic in many instances, but symptomatic patients might present with constipation as the sole manifestation of the Currarino's syndrome among the other wide spectrum of manifestations.Case presentationAn 18-year old woman was diagnosed with a late-recognized Currarino syndrome, presented by a longstanding constipation which had been wrongly diagnosed and treated as Hirschsprung's disease since early childhood.ConclusionLong-lasting constipation could imply to neural tube anomaly such as anterior sacral meningocele with or without association to Currarino's syndrome.

Nerve root prolapse into a spinal arachnoid cyst—An unusual cause of radiculopathy

Arachnoid cysts are rare lesions of the spine and can present with myelopathy, radiculopathy, local pain or a combination of these symptoms. Nerve root prolapse into an arachnoid cyst causing radiculopathy has not been reported before. We report a nerve root prolapse into a spinal arachnoid cyst presenting clinically as radiculopathy. An 18-year-old female patient presented with mid-back pain, right anterior thigh pain and hip flexor weakness. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed an arachnoid cyst at T12-L1 level on the right side. At surgery, a nerve root was seen prolapsing into an extradural arachnoid cyst. The nerve root was replaced back into dural sac and the dural defect closed. At 20 months of follow-up, the patient continues to be asymptomatic with no evidence of recurrence on imaging. Replacing the prolapsed nerve root into the dural sac with meticulous closure of the dural defect could lead to good clinical outcome. We propose a modification to the popular classification of these lesions to better rationalize their surgical management. Classification of extradural arachnoid spinal cysts (Nabors's type 1) should be based on the presence or absence of dural communication. Sacral meningoceles (Nabors’ type 1B) should be excluded from the classification as they have free communication with the thecal sac and are not true spinal cysts.

Sacral Meningocele and Rectal Fistula Associated with Pneumorrhachis and Pneumocephalus

Pneumorrhachis (PR), the presence of air in the spinal canal, is a rare but suggestive radiographic finding, associated to different aetiologies and possible pathways of air entry into the spinal canal. It can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and non traumatic PR. Pneumoencephalus (PE), lack of air in the skull, is the equivalent intracranial phenomenon, associated mostly with traumatic or iatrogenic aetiology. Non traumatic PR and PE, especially when concurrent, are an uncommon radiological finding.

Okkulte sakrale Meningozele – eine diagnostische Herausforderung

Occult sacral meningoceles are a rare causative factor for neural claudication or radiculopathy. Facet joint cysts in the lumbar spine causing similar symptoms are much more frequent. We report the case of a patient with the radiological diagnosis of a facet joint cyst causing neural claudication. During surgery an occult sacral meningocele was diagnosed. In the literature there are only few cases reported. Hence, the findings and important differential diagnoses of cystic epidural lesions in the lumbar spine are discussed.

Rectothecal fistula secondary to an anterior sacral meningocele

A rectothecal fistula secondary to anterior sacral meningocele is an extremely rare disease. To the authors' knowledge, only 2 cases have been reported in the English-language literature. It can cause symptoms by compressing adjacent structures, causing urinary difficulties and constipation. The authors report an unusual case of a patient in whom this condition was diagnosed as an incidental finding. The patient had a sacral myelomeningocele with secondary meningitis to a rectothecal fistula. The authors will briefly review the diagnosis, the various treatments, and the surgical approach to treat this infrequent entity.

Präsakrale Meningozele bei Thalidomid-Embryopathie

A now 27-year-old man, known to have a thalidomide embryopathy with multiple malformations, including a sacral deformity, developed in the course of a few weeks a disorder of bladder emptying, colicky lower abdominal pain and, finally, abnormal stools. Exploratory laparotomy revealed an anterior sacral meningocele, confirmed by computed tomography with intrathecal contrast medium injection. After surgical removal of the meningocele all bladder and rectal disorders disappeared. The course of the disease and the radiological findings are typical of a space-occupying anterior sacral meningocele.

Giant Anterior Sacral Meningocele Presenting as Bacterial Meningitis in a Previously Healthy Adult

Meningocele may be asymptomatic and incidentally discovered. Presenting as a retrorectal mass, sacral meningocele may produce urinary, rectal, and menstrual pain. Anterior sacral meningocele may be the cause of tethered cord syndrome. This article presents a case of a previously healthy 39-year-old man with large meningeal herniation that occupied the entire pelvis who developed symptoms of bacterial meningitis. A 39-year-old man was admitted with fever, chills, headache and photophobia. Escherichia coli was isolated from cerebrospinal fluid culture. Moderate improvement regarding meningeal symptoms was noted due to intravenous antibiotic therapy, but intense pain in the lower back associated with constipation, fecal and urinary incontinence, and saddle anesthesia developed. Abdominal ultrasound was negative. Plain radiographs and computed tomography demonstrated sacral bone defect and retrorectal expansive mass. MRI confirmed anterior sacral meningocele with cord tethering. After posterior laminectomy and dural opening, communication between meningocele and intrathecal compartment was obliterated. Computed tomography-guided percutaneous drainage through the ischiorectal fossa was performed to treat residual presacral cyst. Delayed diagnosis in our patient was related to misleading signs of bacterial meningitis without symptoms of intrapelvic expansion until the second week of illness. In our patient, surgical treatment was unavoidable due to resistive meningitis, acute back pain, and symptoms of space-occupying pelvic lesion. Neurosurgical approach was successful in treatment of meningitis and neurological disorders. Computed tomography-guided evacuation of the residual retrorectal cyst was less invasive than laparotomy, resulting in normalization of defecation and miction despite incomplete evacuation. Further follow-up studies may provide insight into the most effective treatment of such conditions.

Laparoscopic treatment of anterior sacral meningocele

Background Anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. We present a laparoscopic approach as an adjunctive approach. Methods Five women who underwent laparoscopic transperitoneal surgery were clinically, radiologically, and surgically evaluated. Result All 5 patients underwent laparoscopic transperitoneal surgery and showed satisfactory results. They had no major complications. Three patients had headaches as minor complications, but it was gone in at most 3 days. Decrease in operative time, blood loss, and length of hospitalization were the advantages of the procedure. Conclusions The laparoscopic approach to treating anterior sacral meningocele was feasible and safe, with only minor complications.

Anterior sacral meningocele: management in gynecological practice

We describe the case of a young woman with anterior sacral meningocele (ASM), initially identified during a routine ultrasound examination and subsequently diagnosed using magnetic resonance imaging (MRI). ASM is a rare disorder characterized by uni- or multilocular extensions of the meninges from the sacral spinal canal to the retroperitoneal presacral space. Common symptoms include lower back and pelvic pain, constipation, difficulties in defecation, dysmenorrhea and dyspareunia, and urinary incontinence, retention or urgency. Perineal and lower-extremity paresthesias may present when nerve roots are affected. Despite its more posterior location, ASM can mimic an ovarian cyst or other adnexal cystic mass, and in the obstetric patient can present a mechanical obstacle to delivery with a risk of rupture and infection during labor and delivery. Although it is a rare condition, we feel that awareness of the etiology, presentation and imaging characteristics of ASM is of importance and have therefore carried out a review of the literature, taking into account case findings and the obstetric and gynecological management of this disorder.

An elusive pelvic cyst: a case report of an anterior sacral meningocele

We present an interesting case of a large anterior sacral meningocele. Despite its rarity, this anomaly can have serious complications and therefore should not be overlooked. A female presenting with a cystic presacral mass requires detailed imaging and a complete diagnostic workup prior to definitive treatment.