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Objective: To compare cases of dysraphism with ventral tethering of cord with those with dorsal tethering and to find out any differences in the outcome of surgery in them. Methods: We collected the data of 188 consecutively operated tethered cord patients at our institute in the past 7 years and divided them into ventral tethering and dorsal tethering groups. Those that we felt had both dorsal and ventral tethering were excluded. Their preoperative clinical, radiological, and baseline neurophysiological parameters as well as postoperative clinical and radiological parameters were analyzed in a retrospective study. Results: Among the 188 tethered cord patients, 52 (28%) had ventral tethering and 136 (72%) had posterior tethering. Preoperative neurodeficit and cord signal changes as well as absent baseline MEP (of any one muscle) were significantly more associated with ventral tethered cord than the dorsal tethered cord. The neurological deterioration after surgery occurred significantly in the ventral tethered cord group than in the dorsal tethered cord group. Also, the postoperative MRI had more incomplete detethering cases in the ventral group than in the dorsal tethered cord group. Conclusion: Ventral tethered cord is more likely to present with preoperatively neurological deficits. It should be carefully identified in the preoperative MRI, so that the intraoperative difficulties in complete detethering and postoperative deterioration can be anticipated. [ABSTRACT FROM AUTHOR]

Although it was first described over 100 years ago, lumbar puncture is still an important diagnostic tool for a variety of infectious and noninfectious neurologic conditions. With the widespread use of this common and relatively safe performed medical procedure, minor and major complications can occur even when standard infection control measures and good techniques are used, including post lumbar puncture headaches, infection, bleeding, cerebral herniation, radicular pain, and even pneumocephalus in extremely rare cases. We describe a previously unreported complication of lumbar puncture performed for the diagnosis of meningitis in a 33-year-old woman with no medical history causing pneumorrachis, tension pneumocephalus, and sacral meningocele infection leading to death. Lumbar puncture is a simple diagnostic procedure with few complications, but if the technique is incorrectly performed, or if it is accompanied by occult congenital malformations such as sacral anterior meningocele in our case, the consequences can be fatal.

Abstract Background Objective Methods Results Conclusions Anterior sacral meningocele (ASM) is an uncommon variant of spinal dysraphism. Surgical correction for this condition is challenging and optimal corrective approaches are uncertain.To share our experience of managing this rare condition using the posterior trans-sacral approach and provide a contemporary review of the literature.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.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.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. [ABSTRACT FROM AUTHOR]

Introduction: Meningitis secondary to rectothecal fistula is an exceptionally rare phenomena which has previously been reported exclusively in the setting of Currarino Syndrome for the pediatric population. Case presentation: We describe the case of a neonate presenting with polymicrobial meningitis due to rectothecal communication via congenital anterior sacral meningocele in the absence of an anorectal malformation. The authors opted for expeditious surgical resection of the fistulous tract and closure of the thecal sac using a posterior sagittal approach to the presacral space. The patient completed a course of intravenous antibiotics postoperatively. Discussion: This case highlights the first reported neonatal case of rectothecal fistula in the absence of an anorectal anomaly. The surgical approach is described.

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. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele is a rare congenital anomaly encountered in neurosurgical practice. In all, approximately 200 cases of this rare congenital malformation have been reported till date. Surgical management has been accepted beyond doubt as the treatment of choice and posterior surgical approach has been adopted in majority of the cases, however there are no concrete guidelines for choosing anterior or posterior approach. The authors report here an unusual presentation of a giant anterior sacral meningocele in an adult. A 30 year old male, presented with persistent constipation and urinary retention. On evaluation, a giant anterior sacral meningocele of size 13x10x13cm was seen on imaging causing significant compression of the rectum and bladder. A single stage surgery was planned via trans-abdominal approach. Successful excision of the meningocele sac was done along with dural repair, thus relieving the patient of his symptoms. The authors reflect on the cases reported in literature and the approaches used by other surgeons. The authors also discuss in this paper, the reasons for choosing the anterior approach in such rare cases and their observations during the intra and post-operative course. The authors conclude by enumerating the advantages of the anterior approach while also suggesting key operative steps to prevent complications.

Background: Anterior sacral meningocele (ASM) is a rare congenital anomaly. It is characterized by herniation of the dura through a defect in the anterior sacrum. Rarely, however, it may extend to the rectal area through a rectothecal fistula with or without rectorrhea. Case Description: Here, we present a case of ASM associated with a rectothecal fistula and rectorrhea. Surgical closure of the ostium of the cyst through a posterior approach resulted in long-term improvement. Conclusion: An ASM with both rectothecal fistula and rectorrhea is extremely rare. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case series.Objective: Anterior sacral meningocele (ASM) is a rare disorder. We reviewed 11 cases of congenital ASM and classified them into three types based on the anatomy and relationship between the cyst and sacral nerve roots.Summary Of Background Data: The cohort with ASM is relatively large; the classification is novel and has not been previously reported.Methods: Eleven consecutive patients with ASM who underwent surgery between February 2014 and January 2019 were retrospectively analyzed. They included four males and seven females. The dorsal transsacral approach was adopted in all cases. The follow-up time was at least 3 months.Results: We attempted to classify ASM into three types. Of the 11 cases, six were caudal type, two were paraneural type, and three were nerve-root type. The meningocele was ligated after exploring no nerve involvement, in Type I and II. For Type III, the herniating sac and involved nerve roots were ligated when the nerve roots were indicated as nonfunctional on neurophysiological monitoring; otherwise, the sacral nerve roots were protected and imbricated on the residual sac like a hand-in-glove, and sutured to reconstruct the nerves sleeve. Eight cases were accompanied by tethered cord syndrome (TCS); spinal cord detethering was done with one-stage operation. Ten patients' presenting symptoms improved at 3 to 6 months' follow-up; notably, constipation significantly improved. Only one case accompanied by an epidermoid cyst had a second laparoscopic surgery by a general surgeon.Conclusion: Aim of surgical treatment is to obliterate the communication between the subarachnoid space and herniated sac, detether the spinal cord, and resect the congenital tumor. The new classification helps to recognize the relationship between the meningocele and sacral nerve roots, and subsequently adopt different surgical strategies. We consider the dorsal transsacral approach relatively feasible, safe, and with lower complication.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Abstract Background Anterior sacral meningoceles are rare, and usually occur with other malformations of the posterior lower spine. While these are more frequently reported in pediatric cohorts, we report a case in an elderly woman. Case presentation We report on a 71 year-old woman with a recently diagnosed colorectal adenocarcinoma who presented with a severe bacterial meningitis. The cerebrospinal fluid cell count revealed a pleocytosis of 80,000 cells/μl and a severe disturbance of the blood-brain-barrier. Fusobacterium nucleatum was cultured as the causing pathogen. A lumbar MRI showed, in addition to contrast-enhancing meninges as sign of inflammation, a presacral mass. In the next step, the mass was diagnosed as an anterior sacral meningocele connected to the gut. An adequate antibiotic was used to treat the leptomeningitis. The connection between gut and meningocele was closed surgically and the patient recovered well and underwent further treatment of her colorectal adenocarcinoma. Conclusion We report on a case of meningitis with an anterior sacral meningocele that was connected to the gut in a patient with a infiltrative colorectal adenocarcinoma. Anatomic variants have to be considered as rare causes of meningitis with typical intestinal germs.

Background Context: Dural ectasia is widening of the dural sac often seen in patients with Marfan syndrome and other hereditary connective tissue disorders. Dural ectasia can cause specific symptoms and is associated with surgical complications. The knowledge on how and at which age dural ectasia develops is incomplete. There is no established gold standard for diagnosing dural ectasia, making it difficult to compare results from different studies.Purpose: Our primary aim was to explore whether the radiological findings of dural ectasia changed after 10 years in an adult cohort with suspected Marfan syndrome. Our secondary aim was to re-evaluate the radiological criteria of dural ectasia.Study Design: Prospective cohort study.Patient Sample: Sixty-two persons from a cross-sectional study of 105 persons with suspected Marfan syndrome were included in a 10-year follow-up of dural ectasia. Forty-six were diagnosed with Marfan syndrome, 7 with Loeys-Dietz syndrome, and 5 with other hereditary connective tissue disorders. For comparison 64 matched hospital controls were evaluated.Outcome Measures: Previously used radiological criteria for dural ectasia based on quantitative measurements of the lumbosacral spine.Methods: MRI of the lumbosacral spine was performed if not contraindicated, and if so then CT was performed. Differences in the study group between baseline and follow-up were assessed with paired Student t test, Wilcoxon rank signed test, and McNemar test. Receiver operating characteristic curves were constructed to assess the ability of radiological measurement to differentiate between the study and control group.Results: Fifty-two of 58 patients with hereditary connective tissue disorders and 11 controls had dural ectasia at follow-up. Forty-five Marfan patients had dural ectasia at follow-up vs. 41 at baseline. Five Loeys-Dietz patients had dural ectasia at follow-up vs. four at baseline. Twenty-four Marfan and 2 Loeys-Dietz patients had anterior sacral meningocele at follow-up, compared with 21 and 1, respectively, at baseline. Three Marfan patients developed herniation of a nerve root sleeve during follow-up. This was not seen in other individuals. The dural sac ended significantly lower at follow-up, and the dural sac ratio at level L5 was significantly increased from baseline in the Marfan patients.Conclusions: In Marfan and Loeys-Dietz syndrome, dural ectasia may present or worsen during adulthood. The cut-off value of dural sac ratio at level S1 is suggested elevated to 0.64. The results from the present study may help as guidance for appropriate follow-up of patients with dural ectasia. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele (ASM) and neural tube defect are well-known clinical entity. Hirschsprung's disease is rarely associated with ASM, but the association with anorectal malformation is common.

Background Marfan syndrome is a genetic disorder that results in the weakening of connective tissues. Dural ectasia has been defined as a feature of Marfan syndrome and is present in up to 92% of patients. Rarely, dural ectasia can erode through the sacrum expanding into an anterior sacral meningocele. Case Description Information for this case report was gathered from patient notes and imaging from the patient chart. This is a case of a 46-year-old woman who presented with urinary incontinence, early satiety, and back pain in the setting of a known anterior sacral meningocele. Before operative management, the anterior sacral meningocele ruptured with the patient presenting signs and symptoms of intracranial hypotension. Conservative management did not alleviate the pain. She was ultimately managed with posterior sacroplasty followed by anterior sacral meningocele resection and placement of a lumboperitoneal shunt. The patient did not have reaccumulation of the meningocele or recurrent symptoms at the latest follow-up. Conclusions The progression of dural ectasia in Marfan syndrome to an anterior sacral meningocele is uncommon. It is important to identify the characteristics associated with an expanding dural ectasia as this patient's symptoms progressed over time and the meningocele grew large. Given its rarity, there are no guidelines in place regarding size at which repair of an anterior sacral meningocele should occur prophylactically. It is important to review these cases in order continue to learn about progression, management, and outcomes of patients with an anterior sacral meningocele. Highlights • Case report of ruptured anterior sacral meningocele in a patient with Marfan syndrome. • Imaging of preruptured anterior sacral meningocele. • Imaging of ruptured meningocele with herniation of bowel into spinal canal. • Description of 3-staged surgical management of anterior sacral meningocele sac. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions.Methods: A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM.Results: Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion.Conclusions: This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression. [ABSTRACT FROM AUTHOR]

Background: Anterior sacral meningoceles are rare, and usually occur with other malformations of the posterior lower spine. While these are more frequently reported in pediatric cohorts, we report a case in an elderly woman.Case Presentation: We report on a 71 year-old woman with a recently diagnosed colorectal adenocarcinoma who presented with a severe bacterial meningitis. The cerebrospinal fluid cell count revealed a pleocytosis of 80,000 cells/μl and a severe disturbance of the blood-brain-barrier. Fusobacterium nucleatum was cultured as the causing pathogen. A lumbar MRI showed, in addition to contrast-enhancing meninges as sign of inflammation, a presacral mass. In the next step, the mass was diagnosed as an anterior sacral meningocele connected to the gut. An adequate antibiotic was used to treat the leptomeningitis. The connection between gut and meningocele was closed surgically and the patient recovered well and underwent further treatment of her colorectal adenocarcinoma.Conclusion: We report on a case of meningitis with an anterior sacral meningocele that was connected to the gut in a patient with a infiltrative colorectal adenocarcinoma. Anatomic variants have to be considered as rare causes of meningitis with typical intestinal germs. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions.

Background Anterior sacral meningocele (ASM) leading to secondary rectothecal fistula is extremely rare, and to date only 5 such cases have been described in the world literature. Case Description We describe an uncomplicated case of a 52-year-old female patient presenting with cerebrospinal fluid leak from the anus who was investigated and found to have an ASM with rectothecal fistula. The ASM and rectothecal fistula were subsequently repaired using a posterior approach. Pertinent literature review, clinical findings, neuroimaging, and surgical management are described for these rare lesions. Conclusion Early diagnosis and surgical disconnection of the fistulous tract led to satisfactory outcome in the present case and avoided the catastrophic complication of meningitis. [ABSTRACT FROM AUTHOR]

Meningitis secondary to rectothecal fistula is an exceptionally rare phenomena which has previously been reported exclusively in the setting of Currarino Syndrome for the pediatric population. We describe the case of a neonate presenting with polymicrobial meningitis due to rectothecal communication via congenital anterior sacral meningocele in the absence of an anorectal malformation. The authors opted for expeditious surgical resection of the fistulous tract and closure of the thecal sac using a posterior sagittal approach to the presacral space. The patient completed a course of intravenous antibiotics postoperatively. This case highlights the first reported neonatal case of rectothecal fistula in the absence of an anorectal anomaly. The surgical approach is described. [ABSTRACT FROM AUTHOR]

A 54-year-old male presented with a sudden burning sensation during urination and left flank pain. Apart from having congenital facial palsy and malformation of the inner right ear that was linked to thalidomide embryopathy, the patient has always been in good health. Urine examination showed the presence of a urinary tract infection. An abdominal ultrasound revealed a large cyst in the lower abdomen, which on MRI corresponded to a large anterior sacral meningocele (ASM) with sacral agenesis at S1/S2. After antibiotic treatment and the spontaneous passage of a kidney stone, the symptoms resolved. This suggests that the patient's acute symptoms were caused by the urolithiasis and not the ASM. Thalidomide is teratogenic between days 17 and 30 after conception. The neural tube closes between days 20 and 36, therefore, thalidomide embryopathy was the possible cause of ASM in this patient. [ABSTRACT FROM AUTHOR]

We present a case of anterior sacral meningocele (ASM) in 28 yeras female with lower abdominal pain misdiagnosed as adnexal cyst on pelvis ultrasound. She was evaluated with CT scan with 3-D reconstruction followed by MRI and allo reviewed the literature regarding its clinical presentation and radiological findings. This case emphasizes the importance of considering an anterior sacral meningocele in patients with lower abdominal pain or pelvic cystic mass. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele (ASM) and neural tube defect are well-known clinical entity. Hirschsprung's disease is rarely associated with ASM, but the association with anorectal malformation is common. [ABSTRACT FROM AUTHOR]

Background and importance: Anterior sacral meningoceles are lesions that are uncommonly reported and can be associated with other pathology including presacral masses, tethered spinal cord, and syringomyelia. Tethered spinal cord and syringomyelia can result in neurologic deficits, while large meningoceles and presacral masses can have gastroenterologic, urologic, reproductive, and oncologic consequences. Clinical presentation: The authors report a case of a 14-year-old girl with an anterior sacral meningocele, tailgut cyst, and tethered cord with holocord syringomyelia who presented with a tethered cord syndrome, manifested by constipation, urinary retention, bilateral lower extremity weakness, and sensory deficits. After extensive radiographic and urodynamic workups were performed, the patient was treated by the neurosurgery and pediatric surgery teams with a posterior sagittal approach for cord detethering, resection of an intradural cystic mass, resection of the anterior sacral meningocele, and resection of the adjacent presacral mass. After surgical treatment, motor weakness and sensory deficits were resolved, though urinary symptoms persisted. The syrinx resolved after detethering alone. Pathology of the intradural cystic mass and the presacral mass inferior to the anterior sacral meningocele were consistent with tailgut cyst. Conclusion: The patient's clinical and surgical management are discussed, and a literature review related to anterior sacral meningoceles and their related pathologies is presented. An interdisciplinary approach is required for the best treatment of this constellation of findings. [ABSTRACT FROM AUTHOR]

Introduction: The Currarino syndrome is regarded as a developmental disorder based on its recognized etiological heterogeneity. This syndrome is thought to result from abnormal separation of the neuroectoderm from the endoderm. Our aim was to report the neurosurgical management of Currarino syndrome in children and adults and to describe what clinician could do if the Currarino triad was suspected. Case reports: We present five cases of Currarino triad who underwent surgical intervention. All patients had sacral bony deformity, anorectal malformations, and anterior sacral meningocele. A 40-year-old-male had chronic constipation. He was incidentally diagnosed with Currarino syndrome. A 19-year-old-female suffered from a slight weakness in lower extremities and urinary incontinence. Her past medical history was remarkable for anal atresia. The other three cases were children. Conclusion: When an anterior sacral meningocele is encountered, Currarino syndrome should be taken into consideration. Although it is rarity, the Currarino syndrome might be one of the causes of chronic constipation. Endoscopic or endoscope-assisted surgery via a posterior sacral route can be feasible for treatment of some of the patients with anterior sacral meningocele. Anterior meningocele pouch associated with Currarino syndrome will regresses over time following transdural ligation of its neck. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele (ASM) is a rare congenital anomaly, characterized by herniation through a defect in the anterior aspect of the sacrum. We reported a case of ASM associated with neurofibromatosis, which was mimicking a complex ovarian cyst in ultrasonography. ASM can easily be misdiagnosed as an ovarian cyst and needle aspiration can cause intracranial hypotension syndrome or even death. [ABSTRACT FROM AUTHOR]

Abstract: Anterior sacral meningoceles are rare disorders featuring anterior herniation of the meninges through a sacral defect or foramen. They are frequently misdiagnosed as ovarian or abdominal cysts and surgical exploration has resulted in meningitis. In pregnancy it represents an obstacle to delivery of the fetus and rupture of the meningocele during vaginal delivery is a significant risk. The successful multidisciplinary management of a primiparous patient with an anterior sacral meningocele and previous abdominal surgery is presented. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

The Currarino syndrome is a rare triad that is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. We present 4 children with complete Currarino triad who were diagnosed using MRI. Our aim was to report the neurosurgical management of Currarino syndrome in children. All of the patients had chronic constipation and pain in the lumbosacral region. In the plain radiograph, 3 patients had a sacral scimitar-shaped bony abnormality, and 1 patient had total sacral agenesis. There was a narrow anal canal or narrow ventrally displaced anus in all patients. Their anorectal malformations were characterized as anal stenoses (4 patients), associated with Hirschsprung’s disease in 2 cases. In 3 patients, MRI showed tethered cord syndrome in addition to the presacral mass. There was hydrocephalus in 1 patient. Anal stenosis was treated by anal dilatation. In 2 patients, rectal biopsy and temporary colostomy (2 patients) had been performed previously due to Hirschsprung’s disease. We performed a posterior procedure via lumbar and sacral partial laminectomy-laminoplasty and transdural ligation of the neck of the meningocele for anterior sacral meningoceles, or alternatively, tumor excision for other types of presacral lesions. Histopathologically, 3 were cases of anterior sacral meningoceles and 1 was a teratoma. One of them also had a spinal abscess. He required reoperation (twice) and appeared at the time to have improved with medical therapy. All patients improved and stabilized. There were no additional neurological deficits and no recurrence of the presacral mass over the follow-up period (6 years, on average). The family pedigree did not reveal any familial transmission pattern. In cases of Currarino triad, MRI can allow the characterization of the presacral masses. If it is an anterior sacral meningocele or a solid tumor without severe anorectal malformation, it can be managed with posterior lumbar and sacral procedures. Such approaches are performed easily by transdural ligation of the neck of the anterior sacral meningocele or through tumor excision. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Anterior sacral meningocele is an anomaly most frequently presenting as a presacral mass. It is an extension of the dura mater and arachnoid out of the sacral spinal canal into the retroperitoneal and infraperitoneal space through a congenital defect in the sacrum. Spontaneous rupture with subsequent meningitis is the most frequent and dangerous complication. We summarize the management as well as the surgical approaches described in the literature. [ABSTRACT FROM AUTHOR]

Abstract: Background: 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. Case Description: 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. Conclusions: 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. [Copyright &y& Elsevier]

Anterior sacral meningocele is a unilocular or multilocular extension of the dura mater and arachnoid out of the sacral spinal canal into the retroperitoneal and infraperitoneal space. It contains CSF, which in some of the reported cases has been discolored (slightly yellow), and has had an elevated protein content. Surgery with sacral laminectomy and surgery by the transabdominal approach are the treatment options for this malformation. We report a case of a 16-year-old female patient having a large anterior sacral meningocele. She underwent surgical treatment by the abdominal approach, and the meningocele sac was excised. We presented the clinical and radiological features of our patient and discussed them with reference to the literature. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical charactristics, diagnosis and treatment of the anterior sacral meningocele of Currarino syndrome in order to improve the understanding of the disease and the necessity of cooperation department. Methods The clinical data of 1 case of mother and daughter with genetic anterior sacral meningocele of Currarino syndrome were analyzed retrospectively. The clinical characteristics and diagnosis of the disease treatment were explored combined with the literature. Results Mother and daughter with genetic anterior sacral meningocele of Currarino syndrome had different results, because the diagnostic path and operation methods were different. Conclusions Illustrates the anterior sacral meningocele is a part of Currarino syndrome, surgery method that posteriorligation, across the sacrum, or directly from the base of the bulging stiff backbone directly. Repairing meningocele can be used as a treatment of these diseases, because the surgical approach is simple relatively, small trauma, fewer complications, etc. [ABSTRACT FROM AUTHOR]

A case of anterior sacral meningocele which was clearly visualized on whole body computerized tomography is presented. Posterior surgical approach with ligation of the narrow communication between the sacral dural sac and the meningocele alleviated the subjective complaints of a feeling of abdominal distention and of dysuria. For the purpose of postoperative follow-up study, examination by whole body computerized tomography proved to be the best method of evaluating the size of the meningocele and also the state of neighbouring structures. [ABSTRACT FROM AUTHOR]

Currarino's syndrome (CS) is characterized by a triad of a sacral bony defect, anorectal malformations and presacral mass, most commonly an anterior sacral meningocele. Since it was first described as a syndrome by Currarino et al. in 1981, approximately 300 cases have been reported in the literature. Diagnosis of CS in adulthood is rare. We present an adult patient with CS, manifesting by an acute intestinal obstruction. To our knowledge, acute intestinal obstruction in an adult as a presentation of CS has not been reported previously. Colostomy was performed first by the general surgery team to relieve intestinal obstruction caused by the giant cyst. After the final diagnosis of anterior sacral meningocele was established, a second operation was performed for the ligation of the cyst neck through a posterior approach. The size of the cyst gradually reduced over time. A staged approach and the multidisciplinary management, with the collaboration of the general surgery and neurosurgery teams, provided a satisfactory clinical outcome. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele could be asymptomatic or may present as a retrorectal mass with complaining of pelvic pain. We report the case of a 49-year-old who was diagnosed incidentally after an emergency room visit following trauma. Anterior sacral meningoceles could be mistaken as vesical globe. A detailed ultrasonography examination is mandatory and computed tomography or magnetic resonance imaging is the best imaging method. [ABSTRACT FROM AUTHOR]

An anterior sacral meningocele is a diverticulum of the thecal sac protruding anteriorly from the sacral spinal canal into the extraperitoneal presacral space. It is a rare congenital anomaly comprising of a thin wall of fibrous connective tissue, and containing cerebrospinal fluid and, occasionally, adjacent nerve fibers. We report an unusual case of a 48-year-old male who presented with meningitis secondary to a rectothecal fistula arising from an anterior sacral meningocele. [ABSTRACT FROM AUTHOR]

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Anterior sacral meningocele (ASM) is a congenital lesion that arises through errors in the embryonic events that follow the closure of the posterior neuropore. We report a 7-month-old boy with an ASM. The clinical presentation and management are discussed. [ABSTRACT FROM AUTHOR]

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Background Anterior sacral meningocele is a rare congenital anomaly. Case Description This rare anomaly is described in a young woman who presented with recurrent abortion and later with a huge palpable mass of pelvic origin, measuring 14 × 12 cm. Conclusions The various radiologic features, associations such as presacral dermoid as a part of incomplete Currarino syndrome, and the management options available are also discussed. [ABSTRACT FROM AUTHOR]

Anterior sacral meningocele is an unusual lesion that usually presents as a presacral mass. This is a case presentation of a young woman who presented with amenorrhea. On physical examination, a large presacral mass was found. Ultrasonography revealed a large cystic structure. Radiography of the pelvis demonstrated a sacral deformity or “scimitar sign” that is pathognomonic for anterior sacral meningocele. The diagnosis was confirmed by computed tomography with myelographic enhancement. [ABSTRACT FROM AUTHOR]

Abstract: The authors report a case of partial Currarino syndrome in a three and a half year old child with a left hemisacrum agenesis and a presacral mature teratoma. The special aspect of the observation was the apparition of repetitive polymicrobial purulent meningitis (Escherichia coli, Streptococcus B, Hæmophilus influenzae) treated several times with non-specific antibiotics without normalization of CSF, particularly the CSF glucose, which remained low, justifying the use of an antimycobacterial treatment, especially since there was no local or general cause explaining the relapse. During a relapse of meningitis after ten months of antituberculosis treatment, the teratoma was discovered by a spine MRI done to detect any cerebrospinal defect. The authors insist on the fact that the Currarino syndrome must be investigated in case of repetitive purulent meningitis after ruling out the usual causes of meningitis. [Copyright &y& Elsevier]