Anterior sacral meningocele diagnosis [Neurosurgery Wiki]

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====== Anterior sacral meningocele diagnosis ======

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Radiological investigations include plain and contrast radiographs, ultrasound, computed tomography and magnetic resonance imaging (MRI). ‘Scimitar’ sign, a smooth curved unilateral sacral defect simulating shape of Arabic sabre on plain X-ray, is considered to be pathognomonic of ASM
((Kovalcik PJ, Burke JB. Anterior sacral meningocele and the scimitar sign. Report of a case. Dis Colon Rectum. 1988 Oct;31(10):806-7. doi: 10.1007/BF02560112. PMID: 3168668.)).

Contrast enema, which may show displacement of rectum, sigmoid colon and urinary bladder, is now obsolete for diagnosis. Abdominal and spinal sonography should be the first diagnostic investigation and can diagnose ASM and differentiate it from other cystic lesions in the pelvis
((Naidich TP, Fernbach SK, McLone DG, Shkolnik A. John Caffey Award. Sonography of the caudal spine and back: congenital anomalies in children. AJR Am J Roentgenol. 1984 Jun;142(6):1229-42. doi: 10.2214/ajr.142.6.1229. PMID: 6372416.)).

Imaging for screening for ASM and presacral teratoma should be directed at identifying the presacral mass rather than sacral bony defect. Thus computed tomography or MRI is recommended as the screening modality
((Singh SJ, Rao P, Stockton V, Resurreccion L 3rd, Cummins G. Familial presacral masses: Screening pitfalls. J Pediatr Surg. 2001 Dec;36(12):1841-4. doi: 10.1053/jpsu.2001.28860. PMID: 11733920.)).