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Anterior sacral meningoceles (ASMs) are rare lesions often associated with connective tissue disorders. These lesions are typically treated posteriorly via closure of the dural stalk. However, given their insidious nature, ASMs can be quite large on presentation, and this approach may not provide adequate decompression. In this case report, the authors describe the successful treatment of a large ASM through drainage and watertight closure of the cyst with an omental flap.A 43-year-old woman with a history of Marfan syndrome and a large ASM was referred for neurosurgical intervention. The ASM was filling the pelvic cavity and causing severe compression of the bladder. The patient underwent surgical decompression of the cyst through an anterior transabdominal approach and closure of the fistulous tract with a pedicled omental flap. This is the first reported case of successful closure of an ASM with an omental flap. At the 6-month follow-up, the ASM had not recurred on imaging and the patient’s symptoms had resolved.Anterior sacral meningoceles are rare lesions that often require neurosurgical intervention. Although most can be treated posteriorly, large ASMs compressing the abdominal or pelvic organs may require a transabdominal approach. Moreover, ASMs with wide dural stalks may benefit from closure with an omental flap.

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.

Neurologic conditions without prenatal optimization can pose anesthetic and obstetrical challenges. We present a case of Currarino syndrome; an autosomal dominant triad of agenesis of the sacrum, anterior sacral meningocele (ASM) with sacral teratomas, and anorectal stenosis; diagnosed during pregnancy; and the subsequent anesthetic considerations. The location, size, and risk of rupture of the ASM can create obstacles to delivery. Eligibility for neuraxial anesthesia should be made on a case-by-case basis with risk-benefit analysis, and deficits should be documented allowing prompt identification and intervention should complications arise. Multidisciplinary team coordination is vital to help facilitate maternal safety.

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) 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.

Meningitis is a rare but serious complication in patients with Currarino syndrome. We present a 6-year-old girl with a fulminant meningitis due to an enterothecal fistula involving the anterior sacral meningocele. Initial treatment consisted of broad-spectrum intravenous antibiotic therapy and laparoscopic construction of a deviating double-loop ileostomy. This was followed by an elective posterior neurosurgical approach with a sacral laminectomy, evacuation of the empyema, and securing the disconnection of the anterior meningocele from the thecal sac, 10 days after initial hospital admission. The girl made a good postoperative recovery. The treatment strategy in the setting of meningitis due to an inflamed anterior meningocele is discussed and the available literature on the topic is reviewed.

Background An epidermoid cyst is a congenital benign tumor and is extremely rare at the presacral region. Only a few cases have been reported in the literature. Case description We herein report a case of a 40-year-old woman with a giant presacral epidermoid cyst mimicking an anterior sacral meningocele who presented with recurrent abortions. This increases risk to the mother and fetus. Magnetic resonance imaging is the investigation of choice. Conclusions The diagnosis and surgical management of this case are discussed.

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.

An 8-month-old boy presented with high fever with seizures and weakness of legs. Cerebrospinal fluid analysis revealed acute pyogenic meningitis and magnetic resonance imaging revealed anterior sacral meningocele with epidural abscess. He was managed by surgery through posterior approach along with antibiotics. Clinical presentation, differential diagnosis, diagnostic modalities and management of this rare clinical condition is briefly discussed in this article.

Background: Currarino syndrome (CS) is a rare genetic condition that presents with the defining triad of anorectal malformations, sacral bone deformations, and presacral masses, which may include teratoma. Neurosurgeons are involved in the surgical treatment of anterior meningoceles, which are often associated with this condition. The accepted surgical treatment is a staged anterior-posterior resection of the presacral mass and obliteration of the anterior meningocele. Case Description: This case involved a 36-year-old female who presented with late onset of symptoms attributed to CS (e.g., presacral mass, anterior sacral meningocele, and sacral agenesis). She successfully underwent multidisciplinary single-stage approach for treatment of the anterior sacral meningocele and resection of the presacral mass. This required obliteration of the meningocele and closure of the dural defect. One year later, her meningocele had fully resolved. Conclusion: While late presentations with CS are rare, early detection and multidisciplinary treatment including single-state anterior may be successful for managing these patients.

Duru, Soner/0000-0002-3449-4673; WOS: 000332319200024 PubMed: 24013264 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. 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. 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.

years female patient was referred from gynaecology department as a case of mass in pelvis. She was initially investigated for primary infertility in same department. Ultrasonography of abdomen was suggestive of teratoma. Contrast enhanced CT scan of abdomen and pelvis was suggestive of anterior sacral meningocele with scimitar sacral deformity. CT scan findings were confirmed by MRI. Patient underwent excision of anterior meningocele via posterior trans-sacral approach. Intraoperatively, we found huge dermoid cyst within meningocele. Findings latter on confirmed by histopathology. Postoperatively patient recovered without any complications and was discharged on day 10.

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.

Currarino syndrome is a congenital disorder, consisting of a triad of anomalies including an anorectal malformation, sacral anomaly, and a presacral mass. Anterior sacral meningoceles are the most common presacral mass. A young child presented to our institution with an unrepaired anorectal malformation and a large anterior sacral meningocele. We describe how the anterior meningocele affected the imaging work-up.

We present an interesting case of a large anterior sacral meningocele. Despite its rarity, this anomaly can have serious complications and therefore should not be overlooked. A female presenting with a cystic presacral mass requires detailed imaging and a complete diagnostic workup prior to definitive treatment.

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.

A 30-year-old woman with a history of fever and purulent rectal discharge for 3 months was transferred to our department with altered sensorium for several weeks. CSF study was suggestive of pyogenic meningitis with growth of enterococci on incubation. CT brain showed pneumocephalus (figure 1A), and MRI of lumbosacral region showed anterior meningocele compressing on the posterior rectal wall. Pressure erosion of the posterior rectal wall possibly led to purulent rectal discharge. Cases of anterior sacral meningocele have been reported in literature presenting as bacterial meningitis1 and perianal abscess.2 Pneumocephalus and air-fluid level (figure 2A) in the meningocele sac in our case suggest possible infection with gas-producing microorganisms or communication with the gut, or both.

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.

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.

Anterior sacral meningocele is characterized by herniation of the meningeal sac due to a developmental bone defect in the front of a sacrum bone. It was first described in 1837. The sacral meningocele may be congenital or acquired. It is usually discovered during a rectal or pelvic examination as a cystic lesion or discovered incidentally. Most of the symptoms are due to compression on the adjacent organs. In this paper, we present a case of an asymptomatic female patient who had a pelvic cyst detected during a routine obstetric ultrasound examination. We show radiological findings of the detailed postpartum evaluation of the cyst, which led to detection of sacral agenesis, huge anterior sacral meningocele, and significant arcuate uterus.

Anterior sacral meningoceles (ASMs) have a recognized association with a number of connective tissue disorders, including Marfan’s syndrome, neurofibromatosis Type 1 and Ehlers–Danlos syndrome. We present the case of a patient with Marfan’s syndrome and ASMs who was referred to gynaecology owing to dysmenorrhoea and left-sided pelvic pain radiating to the left leg. A transvaginal ultrasound scan (TVUS) detected a left pelvic cystic tubular structure, attributed to a hydrosalpinx, which, in retrospect, likely corresponded to the ASM. The patient went on to have TVUS-guided drainage of this cystic structure, resulting in an ASM abscess. It is difficult to distinguish ASM from the vastly more common hydrosalpinx using TVUS alone, and in patients with an atypical appearing posteriorly positioned cystic pelvic lesion or in the presence of underlying conditions known to be associated with ASMs, MRI should be considered before any interventional procedure to drain the suspected hydrosalpinx transvaginally. The patient was successfully treated using a minimally invasive CT-guided posterior trans-sacral drainage technique.

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.

We describe the first documented radiologic findings of complete Currarino triad presenting as neonatal intestinal obstruction in a Nigerian male child. A 1-week-old male neonate was admitted for rectal agenesis and had a divided colostomy during which an anterior sacral meningocele was discovered intraoperatively. The imaging evaluation revealed further, the triad of a partial sacral defect, anorectal atresia, and anterior sacral meningocele. These radiologic findings define the rare association known as the Currarino syndrome (CS). The CS expresses a wide phenotypic expression, and so its diagnosis may be elusive. This case emphasizes the need for physicians to be cognizant of the clinical presentation and radiologic findings of CS. It is a triad to remember in infants with anorectal malformations and even older children or adults presenting with chronic constipation.

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.

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.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.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.

Purpose: To create criteria for detecting dural ectasia on MR or CT images in adult Marfan patients. Methods: Images were analyzed using a workstation. Parameters that predicted dural ectasia were included in our criteria. Results: Major criteria include: (1) width of dural sac below L5 > width above L4; (2) anterior sacral meningocele. Minor criteria include: (1) L5 nerve root sleeve diameter > 6.5 mm and (2) S1 scalloping > 3.5. Dural ectasia exists if 1 major or 2 minor criteria are present. Conclusion: MR and CT diagnose dural ectasia with high specificity and sensitivity. Our criteria accurately diagnose dural ectasia in adult Marfan patients.

✓ The authors report a case of anterior sacral meningocele associated with a rectal fistula in a patient who had presented 20 years earlier with bacterial meningitis. To their knowledge, this is the first case in which a rectal fistula developed due to an anterior sacral meningocele. The clinical presentation, diagnosis, and treatment of this uncommon lesion is discussed.

✓ 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.

A now 27-year-old man, known to have a thalidomide embryopathy with multiple malformations, including a sacral deformity, developed in the course of a few weeks a disorder of bladder emptying, colicky lower abdominal pain and, finally, abnormal stools. Exploratory laparotomy revealed an anterior sacral meningocele, confirmed by computed tomography with intrathecal contrast medium injection. After surgical removal of the meningocele all bladder and rectal disorders disappeared. The course of the disease and the radiological findings are typical of a space-occupying anterior sacral meningocele.

We report a rare case of congenital type III cystic teratoma that may be falsely diagnosed as an anterior sacral meningocele. A female newborn baby presented with a long, white-colored 4 × 1 cm coccygeal cyst posterior to the anus. Magnetic resonance imaging (MRI) demonstrated that a 10 × 4 cm elliptical intrapelvic and -abdominal mass anterior to the sacrum and coccyx extended inferiorly to the retrorectal space. We intraoperatively found that the cyst consisted of a mostly thin, white wall, but also with small posterior narrow nodules. We suggest that all cysts in the sacrococcygeal area should be excluded from teratoma carefully, with MRI.

Anterior sacral meningocele is a rare condition resulting from herniation of the meninges through a sacral defect. Women with this condition may undergo inappropriate surgery because the correct diagnosis is missed, resulting in serious complications. In labor, the cyst may rupture, with consequent meningitis and high maternal mortality. We report the case of a 31 year-old pregnant woman with an anterior sacral meningocele. We describe the role of magnetic resonance imaging in the evaluation and management planning in this condition. She was delivered by cesarean section at 34 weeks without complications. Accurate diagnosis and delivery by cesarean prior to labor are important in assuring good outcomes in women with anterior sacral meningoceles.

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 causes neurological complications, but meningitis, sepsis, obstetric problems, and bowel and bladder difficulties are common secondary conditions, surgical treatment is the standard for symptomatic or growing masses as these lesions usually do not regress spontaneously. Anterior or posterior approaches are used to repair the dural defect. We present a case of a 14 yr-old female patient with a giant nonsyndromic anterior sacral meningocele that we successfully treated using an open posterior approach. We discuss the treatment options and present a brief review of the literature.

L'association d'une stenose anale congenitale avec un defect sacre en forme de courbe et une masse presacree, est connue sous le nom de triade de Currarino. Les patients presentent une constipation de severite variable qui peut etre en relation avec une combinaison de la compression par la masse presacree, une dysfonction neurogene aussi bien avec la stenose anale elle-meme. Nous avons traite trois patients qui illustrent bien le degre de gravite de cette condition. Tous avaient en association une moelle attachee. Le premier a ete traite par une simple dilatation anale, une liberation de la moelle et une reparation d'une meningocele anterieure. Le second n'a pas ete ameliore par une anoplastie et une intervention neurochirurgicale; une dilatation rectale a ete consideree comme ayant contribue a la constipation et a ete traitee par une resection anterieure basse avec un excellent resultat. Le troisieme malade a developpe un abces ischiorectal qui a necessite drainage et colostomie apres des dilatations inefficaces d'une stenose anale cicatricielle epaisse et profonde; une liberation consecutive d'une moelle attachee et la fermeture de la meningocele anterieure ont ete suivies par une anoplastie; la colostomie a ete fermee a une date ulterieure. Chez tous les patients avec stenose anale, une recherche doit etre conduite pour retrouver une masse presacree et un defect sacre associe. La liberation de la moelle attachee, la resection de la masse presacree et la fermeture de la meningocele anterieure sont essentielles pour les meilleurs resultats fonctionnels possibles

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We present the case of a 26-year-old patient with an anterior sacral meningocele which had been discovered during gynaecologic surgery because of a cystic pelvic mass. Subsequently, the patient underwent two pregnancies. The management of a pregnancy complicated by a coexisting anterior sacral meningocele presents a challenging problem for the obstetrician. Because of the high maternal mortality due to rupture of the meningocele under labor, primary cesarean delivery is indicated as soon as fetal lung maturity is established and was performed in our patient in both pregnancies in the 35 week, without complications for mother and children.

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.

CANYIGIT, MURAT/0000-0003-3188-0082 WOS: 000294501000012 PubMed: 21882098 An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventricles, and pial enhancement were observed on multidetector computed tomography. A ventricular drainage catheter was placed to decompress the hydrocephalus, and drainage was performed urgently. Escherichia coli was isolated from the drainage material. Whole-spine magnetic resonance imaging and fistulography were undertaken on the third day after admission to evaluate for anal and urinary incontinence and pareses of both upper and lower extremities. Spinal arachnoiditis, tethered cord, dysgenesis of the sacrum, and a rectothecal fistula were demonstrated. Specific antibiotic treatment and surgery for fistula tract excision were performed.

A 14 year old girl presented as abdominal distension, on Ultrasonography it appear like Ovarian mass, Computed Tomography of abdomen and magnetic resonance imaging suggest Anterior sacral meningocele, which is very rare case, only less than 150 cases reported in literature.

Polymicrobial meningitis has become increasingly rare during recent decades. Historically, it has mainly been reported as being associated with disorders of the ENT-sphere. The treatment of these infections being optimized, polymicrobial meningitis nowadays is essentially a complication of gastrointestinal or gynaecological disorders and trauma. We present a case of polymicrobial meningitis following puncture of a unrecognized pre-sacral meningocele in a patient with Currarino syndrome and review of the relevant literature.

Background Currarino's syndrome is an autosomal dominant hereditary disease known by the triad of anorectal stenosis, anterior sacral defect, and a presacral mass that is most often an anterior sacral meningocele. Actually this syndrome could remain asymptomatic in many instances, but symptomatic patients might present with constipation as the sole manifestation of the Currarino's syndrome among the other wide spectrum of manifestations. Case presentation An 18-year old woman was diagnosed with a late-recognized Currarino syndrome, presented by a longstanding constipation which had been wrongly diagnosed and treated as Hirschsprung's disease since early childhood. Conclusion Long-lasting constipation could imply to neural tube anomaly such as anterior sacral meningocele with or without association to Currarino's syndrome.

Anterior sacral meningocele is a rare congenital condition. Among 177 individuals familial occurrence was reported only seven times. In this report a family in which five members had anterior sacral meningoceles is presented and an autosomal dominant inheritance is suggested.

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.

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.

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.