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Anterior Sacral Meningocele

Authors:
Yousuf Aziz Khan at Ayub Medical College
Yousuf Aziz Khan
Tayyaba Batool at King Fahad Hospital Al Baha
Tayyaba Batool
  • King Fahad Hospital Al Baha
Naima Rasool at lahore medical and dental college
Naima Rasool
Yaqoot Jahan at Dow University of Health Sciences
Yaqoot Jahan
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Abstract

Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such case was seen in a baby girl aged 2 months, who was admitted with abdominal distension and urinary difficulty for one week. She had a lower abdominal mass which investigated by MRI, turned out to be an anterior sacral meningocele causing her symptoms. The meningocele was excised successfully via an open abdominal approach. Postoperative recovery and follow-ups remained uneventful. Presentation, various diagnostic modalities and treatment options for an anterior sacral meningocele are briefly discussed.
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... Meningoceles sacrais anteriores são raros exemplos de disrafismo espinhal. [1][2][3][4][5][6][7][8] Originam-se da herniação do saco dural através de um defeito ósseo na parede anterior sacrococcígea. [1][2][3]5,6,[8][9][10][11] Essa condição foi descrita pela primeira vez em 1837 por Bryant apud Dios Seoane et al., 1 Funayama et al. 12 e Hino et al. 13 e existem, aproximadamente, 250 casos relatados até os dias atuais. ...
... [1][2][3]5,6,[8][9][10][11] Essa condição foi descrita pela primeira vez em 1837 por Bryant apud Dios Seoane et al., 1 Funayama et al. 12 e Hino et al. 13 e existem, aproximadamente, 250 casos relatados até os dias atuais. 2,4,6,9,14,15 A tríade defeito ósseo, malformação anorretal e uma massa pré-sacral configura a síndrome de Currarino, 1,6,8,10,[14][15][16][17][18][19][20] e tal massa pode consistir de um tumor, de uma meningocele sacral anterior ou da associação de ambos. 8,16 Apresenta incidência desconhecida 15 e acredita-se ser uma desordem de transmissão autossômica dominante. ...
... A meningocele sacral anterior, além de ser uma condição rara em nosso meio, ocorrendo principalmente em pacientes do sexo feminino, 1,2,4,9,[12][13][14]17,19,20 possui várias formas de apresentação clínica, provavelmente relacionadas à compressão de estruturas circundantes, causando sintomas como constipação crônica, distúrbios urinários, dismenorreia, dores pélvicas ou lombares, além de hiperalgesia perineal e tônus reduzido no esfíncter anal e músculo detrusor. 1,9 Os estigmas cutâneos clássicos e espinha bífida posterior podem estar ausentes. ...
Meningocele sacral anterior associada a fístula retotecal e meningite polimicrobiana: relato de caso
Article
Full-text available
  • Mar 2014
Resumo Meningoceles sacrais anteriores são exemplos raros de disrafismo espinhal, originados da herniação do saco dural, através de um defeito ósseo na parede anterior sacrococcígea. Essa condição foi descrita pela primeira vez em 1837 por Bryant, e existem, aproximadamente, 250 casos relatados até os dias atuais. A tríade defeito ósseo, malformação anorretal e massa pré-sacral configura a síndrome de Currarino, e tal massa pode consistir de um tumor, de uma meningocele sacral anterior ou da associação de ambos. Tal síndrome apresenta incidência desconhecida, e acredita-se que seja uma desordem de transmissão autossômica dominante. O diagnóstico ainda é desafiador, apesar da evolução dos exames de imagem. Tomografia computadorizada (TC) e ressonância magnética (RNM) são primordiais, sendo a última o melhor exame para caracterização. A radiografia simples pode ajudar demonstrando o defeito ósseo sacral e o sacro em “cimitarra”, sendo indicada para triagem de transmissão familiar. A maioria dos pacientes apresenta constipação e sintomas vesicais compressivos. A meningite é uma complicação rara e séria da meningocele sacral anterior, e a associação entre fístula retotecal e pneumoencéfalo foi relatada em apenas dois artigos de língua inglesa. O tratamento deve ser cirúrgico, uma vez que não há possibilidade de fechamento espontâneo. Em casos não tratados ou com atraso diagnóstico, a mortalidade é superior a 30% quando associados à infecção. Descrevemos um caso de meningocele sacral anterior acometendo uma jovem de 17 anos, assintomática até então, que apresentou meningite polimicrobiana como quadro inicial devido a uma fístula retotecal.
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... Si presenta come una formazione diverticolare del sacco tecale che protrude nello spazio presacrale extraperitoneale. La sottile parete di tale diverticolo è composta da uno strato esterno rappresentato dalla dura madre e da uno interno rappresentato dall'aracnoide ed è in comunicazione con il sacco tecale intraspinale [6]. ...
... It is a diverticulum of the thecal sac protruding into the extraperitoneal presacral space. The thin wall of this diverticulum consists of an outer layer of dura mater and an inner layer of arachnoid and is in communication with the intraspinal thecal sac [6]. ...
Imaging in congenital deformities of the spinal cord
Article
  • Jan 2012
  • RADIOL MED
Vertebromedullary malformations are a heterogeneous group of anomalies of mesenchymal and neuroectodermal tissue differentiation or closure in the midline of the back. On the basis of an embryological analysis, the authors describe the more common malformations, placing them at different times of onset and describing the pathological features and radiological findings based on the use of the most appropriate imaging techniques. The most common malformations have been divided into dysraphic and nondysraphic types and malformations affecting the vertebral bodies. The most complex malformations are detected during the antenatal period by ultrasound or foetal magnetic resonance imaging (MRI). Conversely, during the postnatal period, when the patient's clinical conditions do not warrant emergency surgical treatment, the disorder can be better defined with a detailed MRI scan of the brain and spinal cord. In less complex dysraphisms, although MRI is the imaging modality of choice, it may be useful to integrate the study with plain radiography (X-ray) and multidetector computed tomography (MDCT) for a better assessment of the skeletal components. In these disorders, the use of imaging is aimed at both identifying malformative defects and postoperative follow-up of more complex forms.
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[Anterior sacral meningocele with urologic manifestations. Report of 3 cases]
Article
  • Jul 1992
  • PROG UROL
Anterior sacral meningocele is defined as a spinal fluid-filled thecal sac in the pelvis communicating with the spinal subarachnoid space through a defect in the anterior sacral wall. Since scimitar shape of the sacrum is characteristic, diagnosis is easily confirmed by echography and myelography. The sac very often contains benign tumors and a thickened filum terminale which can achieve a tethered cord syndrome. This congenital malformation, whose autosomal inherited condition has been proposed, has usually few characteristic symptoms but can present itself as a neurogenic bladder from tethered cord origin. Neurosurgical treatment can prevent rupture of the meningocele with meningitis. In addition to symptomatic treatment of the neurogenic bladder, the urologist must advise neurosurgical operation to preserve potency and cure specific bladder dysfunction secondary to tethered cord syndrome.
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Anterior sacral meningocele occurring in a family
Article
  • Jun 1973
1. A case of anterior sacral meningocele is described in members of a family consisting of a woman, her father and his brother. 2. This is the first recorded case of this anomaly in members of the same family of different sex, and only the second recorded case of occurrence in the same family.
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Anterior sacral menincomyelocele with sacrococcygeal teratoma
Article
  • Jun 2004
Anterior sacral meningocoele with sacrococcygeal teratoma is a rare entity. The cystic mass arising from anterior sacral and coccygeal defect, lies in the retrorectal space between the rectum and sacrum. It produces a variety of symptoms depending on its size and contents and constitutes a diagnostic problem. Such a rare association of two pathologies is presented, with review of literature, in an infant who had an anterior meningocoele with sacrococcygeal teratoma. Both the pathologies were surgically corrected individually, about a month apart.
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Anterior Sacral Meningocele With Presacral Cysts: Report of a Case
Article
  • Dec 2004
Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.
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Resection of a giant anterior sacral meningocele via an anterior approach: case report and review of literature
Article
  • Aug 2006
  • SURG NEUROL
An anterior sacral meningocele is a rare form of spinal dysraphism that is sometimes associated with syndromes such as Currarino and Marfan syndromes. These lesions rarely cause neurological complications, but meningitis, sepsis, obstetric problems, and bowel and bladder difficulties are common secondary conditions. The lesions can even be fatal. Because these lesions usually do not regress spontaneously, surgical treatment is the standard for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior or posterior approaches. We present a case of a 16-year-old female patient with a giant nonsyndromic anterior sacral meningocele that we successfully treated using an open anterior approach. We discuss the treatment options and present a brief review of the literature. Although the posterior approach remains the treatment of choice for most lesions, we believe that the anterior laparotomy provides excellent exposure and is a safe alternative approach for the treatment of selected lesions. Patients with these lesions should be cared for by a multidisciplinary team.
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Anterior sacral meningocele. A case report
Article
  • Jul 2007
A case of anterior sacral meningocele in a 6-year-old girl is reported. The laminotomies of L5, S1, and S2 vertebrae were performed through a median posterior approach. The communication between the subarachnoid space and the meningocele was closed using dural fibrin patch, which has not yet been described in the literature. The relevant literature is reviewed.
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Laparoscopic treatment of anterior sacral meningocele
Article
  • Nov 2007
  • SURG NEUROL
Anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. We present a laparoscopic approach as an adjunctive approach. Five women who underwent laparoscopic transperitoneal surgery were clinically, radiologically, and surgically evaluated. 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. The laparoscopic approach to treating anterior sacral meningocele was feasible and safe, with only minor complications.
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Rectothecal fistula secondary to an anterior sacral meningocele: Case report
Article
  • Jun 2008
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.
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