Giant anterior sacral meningocele and posterior sagittal approach.
OBJECTIVE
Anterior sacral meningocele (ASM) is a rare congenital malformation. Often while still asymptomatic, ASM may achieve a considerably size, to the extent of exerting a mass effect on the pelvic structures. Spontaneous rupture with subsequent septic meningitis is the most frequent and dangerous complication. The meningocelic sac is usually isolated by a surgical procedure that requires a sacral laminectomy or a transabdominal approach. Recently an alternative surgical technique, the posterior sagittal approach, has been proposed.


METHODS
We report on a 15-year-old girl with a long clinical history of constipation and sporadic cystitis. Radiological examinations showed progressive enlargement of a presacral lipomeningocele, which grew to 12x14 cm. A posterior sagittal approach was performed; the stalk was ligated, the sac totally excised and a small associated tumour removed. No intra-/post-operative complications were observed.


CONCLUSIONS
The posterior sagittal approach is an easy and safe surgical technique for the treatment of ASM, as it allows a complete isolation of the lesion and the removal of associated tumors without significant morbidity.
Paediatric Neurosurgery, Catholic University of Medical School, Largo A. Gemelli 8, 00168 Rome, Italy. lucamax30@hotmail.com
Luca
L
Massimi
Alessandro
A
Calisti
Michalis
M
Koutzoglou
Concezio
C
Di Rocco
D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000000981:diagnostic imaging / Q000601:surgery*; D012447:Sacrum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods