Laparoscopic treatment of anterior sacral meningocele

Trapp, Claudemir; Farage, Luciano; Clatterbuck, Richard E.; Romero, Frederico R.; Rais‐Bahrami, Soroush; Long, Donlin M.; Kavoussi, Louis R.

doi:10.1016/j.surneu.2006.11.067

Cited by 20 publications

(13 citation statements)

References 13 publications

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“…The authors cited easy dissection and decreased risk of damage to adjacent structures as the principal advantages of this approach. 26 However, the limited experience explains that the role of endoscopy in the evaluation and treatment of meningoceles is still being assessed. 20 Moreover, this type of endoscopy is less familiar to the spine surgeon.…”

Section: Discussionmentioning

confidence: 99%

Successful management of a giant anterior sacral meningocele with an endoscopic cutting stapler: case report

Sunna

Westwick

Zaïri

et al. 2016

SPI

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Anterior sacral meningoceles (ASMs) are rare defects in the sacrum with thecal sac herniations and symptoms that commonly include constipation, dysmenorrhea, and urinary disturbances. An ASM causing hydronephrosis and acute renal failure from compression of the lower portion of the urinary tract is a rare clinical entity. Only one other case has been reported. The authors present the case of a 37-year-old man admitted for obstructive renal failure and hydronephrosis due to a giant ASM that measured 25 × 12 × 18 cm and compressed the ureters and bladder. The ASM was successfully treated via an anterior transabdominal approach in which the authors used a novel technique for watertight closure of the meningocele pedicle with an endoscopic cutting stapler. The authors review the literature and discuss the surgical options for the treatment of ASMs, specifically the management of ASMs in the context of obstructive renal failure and hydronephrosis.

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Section: Discussionmentioning

confidence: 99%

Successful management of a giant anterior sacral meningocele with an endoscopic cutting stapler: case report

Sunna

Westwick

Zaïri

et al. 2016

SPI

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“…A variety of agents have been described to aid in primary closure, including myofascial patch, autologous fat, cadaveric dura, pericardial patch, fibrin glue, and Gelfoam, 11,17 and we used most of these in our repair. Some authors have described successful repair with a laparoscopic approach alone, but this has only been reported for a very small fistulous connection 12 or for simple drainage without definitive repair, 15 and even those who have used the laparoscopic technique have stated that it is contraindicated in the presence of a large anterior sac. 15 Because of the pseudomeningocele's very large size and its association with pelvic and abdominal contents in our case, we selected an open anterior approach as the best exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have described successful repair with a laparoscopic approach alone, but this has only been reported for a very small fistulous connection 12 or for simple drainage without definitive repair, 15 and even those who have used the laparoscopic technique have stated that it is contraindicated in the presence of a large anterior sac. 15 Because of the pseudomeningocele's very large size and its association with pelvic and abdominal contents in our case, we selected an open anterior approach as the best exposure. Weng et al described success in a series of postsurgical giant pseudomeningoceles (not involving Marfan syndrome) through the use of a combined treatment of open revision and extirpation, repair of dural tears, and implantation of a subarachnoid catheter for drainage.…”

Section: Discussionmentioning

confidence: 99%

Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome

Stone

Bergmann

Takamori

et al. 2015

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Defective collagen biosynthesis in Marfan syndrome predisposes to dural defects such as dural ectasia, meningocele, and pseudomeningocele; thus, an increased index of suspicion for these conditions should be present in the clinical setting of Marfan syndrome. The authors describe a young woman with Marfan syndrome who was being treated with anticoagulants for a prosthetic heart valve and who presented with a spontaneous retroperitoneal hemorrhage requiring surgical evacuation. No CSF leak was encountered at surgery, but she developed progressively more severe positional headaches over the following year. She then experienced the sudden onset of acute urinary obstruction, at which time CT revealed a 17 × 15 × 13–cm presacral pseudomeningocele communicating with the thecal sac through a sacral bone defect. An anterior surgical approach was used for drainage of the pseudomeningocele as well as for primary closure of the dural defect with a bovine pericardial patch and autologous subcutaneous fat graft. After a short period of lumbar subarachnoid drainage of the CSF, the patient was able to resume normal activity without recurrent symptoms. To the authors' knowledge, such a pseudomeningocele in a patient with Marfan syndrome has been reported only twice, and this case features the largest pseudomeningocele to date. They also review the pertinent literature regarding presentation, diagnosis, and management of these lesions.

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“…[2122] This is especially useful for narrow-based ASM which may be suture ligated. A posterior sagittal approach may be useful in management of ASM associated with anorectal malformations in Currarino syndrome.…”

Section: Discussionmentioning

confidence: 99%