Fig 5 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Source publication
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 transien...
Contexts in source publication
Context 1
... Sacral Meningocele ASM may be carried out based on only CT evidence which cannot detect intraspinal anomalies. Therefore, we propose four major surgical treatment paradigms based on the neurosurgical requirements (Fig. 5). This treatment tree for ASM is based on the associated neural structures and the size of the ostium of ASM, which can be measured by MR ...
Context 2
... to ligate posteriorly 12,35) or if a pelvic mass is present. 10,24) This approach does not consider any associated neural anomaly in the thecal sac. We believe that this approach can still be applied to ASM with associated solid masses but without caudal spinal cord anomalies by providing wide exposure of the surrounding anatomical structures (Fig. 5). Laparoscopic treatment is another choice for ASM with a rather small ostium. 6) A huge ASM problematic for the prone position 13) requires cyst reduction through the anterior approach prior to the posterior ...
Context 3
... dissection around the sac (Fig. 4B). 9) A free fascial graft seems to carry the risk of later absorption resulting in re-accumulation of the ASM. Posterior mid-sagittal approach: This approach has great advantages for surgical correction of anorectal anomalies such as imperforate anus as well as an associated solid mass connected to the ASM (Fig. 5). This procedure was combined with posterior sagittal anorectoplasty in 11 cases of Currarino triad. 8,23) The disadvantage of this approach is the difficulty in accessing a stalk emerging from high on the sacrum. 33) Preoperative assessment by MR imaging and/or CT is important for the success of this ...
Similar publications
BACKGROUND
Multiple-site open neural tube defects (MNTDs) and multiple-site split cord malformations (MSCMs) are extremely rare congenital anomalies that are defined by the simultaneous noncontiguous occurrence of more than one neural tube defect (NTD) and split cord malformation (SCM), respectively, in a single case with normal neural tissue in be...
Background: Occult spinal dysraphism (OSD) can lead to tethered spinal cord (TSC) which is the result of mechanical rostrocaudal traction on the spinal cord. It is a clinical condition of various origins. Affected patients may have skin markers. Properly timed surgical intervention may prevent the long-term neurological deficits, while delayed surg...
Citations
... Management of CS depends on the existence of a presacral mass, an anorectal malformation, and a fistula between the colon and spinal canal. Various therapeutic strategies have been reported [4,10,12]. Surgical treatment of a presacral mass may involve a posterior sagittal approach, a sacral laminectomy, or an anterior abdominal approach when the presacral mass is too large. The posterior sagittal approach with or without anorectoplasty has been reported as the best method of treating an anorectal malformation with the simultaneous excision of the presacral mass [13]. ...
Currarino triad is a rare clinical condition. The Currarino triad refers to a specific malformation
complex characterized by three main features – congenital anorectal stenosis (or any type
of low anorectal malformation), anterior sacral defect, and a presacral mass that may be a
meningocoele/a teratoma/an enteric cyst or a combination thereof. We are presenting here a
case of late presentation of the Currarino triad in a 7‑year‑old female child.
... Management of CS depends on the existence of a presacral mass, an anorectal malformation, and a fistula between the colon and spinal canal. Various therapeutic strategies have been reported [4,10,12]. Surgical treatment of a presacral mass may involve a posterior sagittal approach, a sacral laminectomy, or an anterior abdominal approach when the presacral mass is too large. The posterior sagittal approach with or without anorectoplasty has been reported as the best method of treating an anorectal malformation with the simultaneous excision of the presacral mass [13]. ...
Currarino triad is a rare clinical condition. The Currarino triad refers to a specific malformation
complex characterized by three main features – congenital anorectal stenosis (or any type
of low anorectal malformation), anterior sacral defect, and a presacral mass that may be a
meningocoele/a teratoma/an enteric cyst or a combination thereof. We are presenting here a
case of late presentation of the Currarino triad in a 7‑year‑old female child.
... 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). ...
The differential diagnosis of cystic adnexal masses, some placed retroperitoneally, includes various pathologies. Preoperative diag�nosis is important to prevent major neurological deficits during surgery. Herein, we present a case of anterior sacral meningocele diagnosed in an infertile woman using magnetic resonance imaging (MRI) and eliminated with surgery. An MRI performed to determine the origin of retroperitoneal fixated masses helps direct the patient to the right consultant department and may avoid an inappropriate surgical approach, which may lead to a failure. A retroperitoneal mass, such as anterior sacral meningocele, may contribute to the pathogenesis of infertility by distorting the utero-tuboovarian anatomy.
... Management of CS depends on the existence of a presacral mass, an anorectal malformation, and a fistula between the colon and spinal canal. Various therapeutic strategies have been reported [14][15][16]. Surgical treatment of a presacral mass may involve a posterior sagittal approach, a sacral laminectomy or an anterior abdominal approach when the presacral mass is too large. The posterior sagittal approach with or without anorectoplasty has been reported as the best method of treating an anorectal malformation with the simultaneous excision of the presacral mass [8]. ...
Currarino syndrome (Currarino triad) was described in 1981 as a triad syndrome with a common embryogenesis in infants and with three characteristics: anorectal stenosis, a defect in the sacral bone, and a presacral mass. We describe here an unusual case of Currarino syndrome in an adult presenting with a presacral abscess but no meningitis.
A 32-year-old Japanese man presented with fever, arthralgia and buttock pain. A digital rectal examination showed mild rectal stenosis with local warmth and tenderness in the posterior wall of his rectum. Computed tomography showed a scimitar-shaped deformity of his sacrum and an 8cm presacral mass, which continued to a pedicle of his deformed sacrum. This was diagnosed as Currarino syndrome with a presacral abscess. The abscess was drained by a perianal approach with our patient treated with antibiotics. His symptoms soon disappeared. After three months, an excision was performed through a posterior sagittal approach. His postoperative course was uneventful and he was discharged 10 days after surgery. A histopathological examination revealed an infected epidermoid cyst. He has been free from recurrence as of four years and six months after surgery.
We report a case of Currarino syndrome in an adult who presented with a presacral abscess but no meningitis. Abscess drainage followed by radical surgery resulted in a successful outcome.
... Although plain radiographs and computed tomography scans may demonstrate an asymmetrical, crescent-, sickle-, or scimitar-shaped sacrum, 24 MR imaging is the best diagnostic modality for providing information that is useful in establishing a treatment strategy in patients with a meningocele as well as associated craniospinal abnormalities such as thickened terminal filum, syringomyelia, low conus medullaris, and tethered cord. 5,6,9,10,18,20 Depending on the neurosurgical requirements in a given case, the surgeon may use a sacral laminectomy approach, an anterior abdominal approach, a posterior midsagittal ap-proach, or laparoscopic treatment by either an anterior or posterior approach. 3,15,[19][20][21] Sacral laminectomy is the most widely used approach for cases such as ours, in which no presacral mass is present. ...
... 5,6,9,10,18,20 Depending on the neurosurgical requirements in a given case, the surgeon may use a sacral laminectomy approach, an anterior abdominal approach, a posterior midsagittal ap-proach, or laparoscopic treatment by either an anterior or posterior approach. 3,15,[19][20][21] Sacral laminectomy is the most widely used approach for cases such as ours, in which no presacral mass is present. 17,20 The anterior approach has been used when a pelvic mass is present or the neck of the meningocele is too large to ligate. ...
... 3,15,[19][20][21] Sacral laminectomy is the most widely used approach for cases such as ours, in which no presacral mass is present. 17,20 The anterior approach has been used when a pelvic mass is present or the neck of the meningocele is too large to ligate. 21 The posterior midsagittal approach has been used for cases with associated anorectal anomalies. ...
Currarino triad is a rare embryological complex of congenital caudal anomalies, including anorectal malformation, sacral osseous defect, and presacral mass, that results from abnormal separation of the neuroectoderm from the endoderm. The authors present an unusual case of a patient who had, in addition to the classic features of this syndrome, holocord syringomyelia, low conus medullaris, and tethered cord demonstrated by magnetic resonance imaging. They also discuss the embryological significance of this clinical entity and briefly review the relevant literature.
More cases of symptomatic cystic lesions of spine are being detected due to easy availability and screening of spine for chronic back pains. These incidentally found cystic lesions, most common is Tarlov cyst, are managed conservatively if clinico-radiological mismatch is there. However symptomatic lesions require surgery in the form of excision, shunt or image guided tap. These cases require long-term follow-up as they are prone for recurrence.
Currarino syndrome or Currarino triad is a complex condition consisting of congenital anomalies. The triad consists of anterior sacral mass (meningocele, teratoma or dermoid/epidermoid cyst), sacral bone defect (hypoplasia, agenesis ), anorectal malformation/congenital anorectal stenosis. This condition is named after Dr Guido Currarino, an Italian-American paediatric radiologist, who first described it in 1975. This needs a multidisciplinary treatment approach. We describe a case of successfully managed young adult with Currarino syndrome. The latest artificial intelligence tool, Chat Generative Pre-Trained Transformer (ChatGPT), helped to write this case report.
Background:
Anterior sacral meningocele (ASM) is an uncommon variant of spinal dysraphism. Surgical correction for this condition is challenging and optimal corrective approaches are uncertain.
Objective:
To share our experience of managing this rare condition using the posterior trans-sacral approach and provide a contemporary review of the literature.
Methods:
Retrospective review of case notes, operative records, and imaging of eligible patients treated via the posterior trans-sacral approach between 2006 and 2020 at our regional neurosciences centre.
Results:
Three patients, two females and one male with a mean age of 30 years (range 16-38), were treated. Presenting symptoms included lower abdominal pain and recurrent miscarriages. Patients underwent corrective surgery using the posterior approach involving a sacral laminectomy, durotomy and closure of the communicating fistula. A single patient required reoperation due to early recurrence. Another patient proved challenging because of a very large sacral fistula and required two procedures due to the development of high-pressure headaches secondary to a recurrence. All patients improved symptomatically postoperatively and remained symptom free at the last clinic follow-up and have been discharged. Following review of the literature, only two other non-syndromic cases have been described.
Conclusions:
ASM is an uncommon congenital abnormality, typically presenting with mass effect symptoms secondary to a presacral cystic mass. Surgical management using a posterior approach to close the meningeal sac is feasible and less invasive than an anterior approach. Long term clinical outcomes in our series were satisfactory.
BACKGROUND
Anterior sacral meningocele (ASM) is a defect in the closure of the neural tube. Patients can be asymptomatic or present with genitourinary, neurological, reproductive, or colorectal dysfunction. Magnetic resonance imaging (MRI) is the gold standard test because it can assess communication between the spinal subarachnoid space and the lesion and identify other abnormalities. Surgical correction is the definitive treatment because untreated cases have a mortality rate of more than 30%.
OBSERVATIONS
A 24-year-old woman with Marfan syndrome presented with polyuria, recurrent urinary tract infections, and renal injury for 3 months along with a globose abdomen, with a palpable mass in the middle and lower third of the abdomen that was massive on percussion. MRI showed an ASM consisting of two cystic lesions measuring 15.4 × 14.3 × 15.8 and 6.7 × 6.1 × 5.9 cm, respectively, compressing the distal third of the right ureter and causing a hydroureteronephrosis. Drainage and ligature of the cystic lesion were performed. The urinary outcome was excellent, with full recovery after surgery.
LESSONS
ASM should be suspected in all abdominal masses with progressive symptoms in the setting of Marfan syndrome. Computed tomography and MRI are important to investigate genitourinary anomalies or other types of dysraphism to guide the best surgical approach.
Background
Intracranial hypotension (IH) is an underdiagnosed, but important cause of new-onset, daily persistent headache, especially among the young- and middle-aged population. It results from a cerebrospinal fluid (CSF) leak with subsequent lowered CSF pressure.
Case Description
A 37-year-old female presented to the emergency department with sudden onset severe headaches. Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC). The night before admission, she had watery discharge from the recurrent PC and severe diffuse positional headaches associated with photophobia and neck pain. The head computed tomography showed pneumocephalus in the posterior fossa and a spine magnetic resonance imaging revealed an anterior sacral meningocele (ASM) in close contact with the recurrent PC. A final diagnosis was made of headaches due to IH. The leakage site was the rupture of the ASM in the PC. The surgical repair of the ASM was achieved suturing two overlapping dural flaps. There was no more CSF leakage from the PC and the headaches disappeared.
Conclusion
This is a unique case of IH due to the rupture of an ASM into a recurrent PC. The association of an ASM and PC, at the best of our knowledge, is unique. Moreover, the fistulation of the ASM to the PC is exceptional. ASM can be successfully closed with a posterior approach, using two overlapping dural flaps.
