Surgical Strategy for Anterior Sacral Meningocele-Two Case Reports-

Abstract

A 25-year-old male presented with an anterior sacral meningocele (ASM) manifesting as repeated urinary tract infections. Surgical correction was completed by simple ligation of the thecal sac next to the ostium via sacral laminectomy, and the thickened filum terminale was sectioned. A 22-year-old female presented with an ASM manifesting as transient difficulty in micturition. Subsequent to sacral laminectomy, the thickened filum terminale was sectioned. However, an aberrant nerve root over the ostium made simple ligation hazardous, so that transdural suture around the ostium was carried out. Complete obliteration was confirmed 5 months after the surgery. Magnetic resonance (MR) imaging could clearly demonstrate the involvement of neurologically important structures. Surgical strategy for ASM based on neurosurgical considerations is proposed, because of the frequent association of caudal spinal cord anomaly as well as presacral mass lesion. Intraoperative assistance systems such as endoscopy for cyst content examination and neurophysiological monitorings are recommended. Several months follow up with MR imaging is required to confirm successful surgical correction.

Anterior sacral meningocele mimicking an adnexal mass in an infertile woman: a report of an extremely unusual case

“…Because of the poor visualization resolution, such as revealing connection between the sacral spinal canal and the pathology, ultrasonography should not be considered primarily (8). MRI is the gold standard for the diagnosis of ASM, which allows for the most accurate preoperative imaging to determine the surgical course (3,10). ASMs can be misdiagnosed as an adnexal mass in gynecological practice; however, it is usually located posteriorly and both ovaries may be visualized separately (11).…”

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

“…Principal factors that influence surgical approach include size of the ASM, size of the ostium, and presence of tumors. 25 The anterior transabdominal approach was first introduced as a means of obtaining direct access to the ASM; however, surgical risks of trauma to adjacent structures and high rates of complications due to incomplete "watertight" dural closure have limited acceptance of this approach. However, this technique is highly applicable in the case of large ASMs or large ostium, and with careful dissection of visceral structures, risks can be minimized.…”

A Case of Type III Cystic Sacrococcygeal Teratoma

“…In addition, Tani et al [16] reported that 33 cases of anterior sacral meningoceles in the literature which were diagnosed with MRI since 1988 showed combined presacral solid mass in 9 cases (8 teratoma and 1 dermoid tumor). Therefore, diagnosis with high-resolution images might be important to differentiate a cystic SCT from other anterior sacral meningoceles, when a presacral cystic mass without any anomaly is present.…”