Anterior Sacral Meningocele Approaches

• Surgical management of a rare giant sacral meningocele in a child
• Successful Management of Multiple Giant Anterior Sacral Meningoceles Through an Anterior Approach in a Patient With Marfan Syndrome: A Case Report and Literature Review
• Posterior median surgical approach to anterior sacral meningocele complicated by rectothecal fistula
• Posterior Surgical Ligation and Cyst Decompression -via Needle Puncture- of a Large Anterior Sacral Pelvic Meningocele Through Posterior Sacral Laminectomy
• Successful sacral neuromodulation treatment of refractory faecal incontinence in a patient with spina bifida and partial sacral agenesis
• Intrasacral meningoceles: Clinical presentation, surgical management, and postoperative outcome: The Giannina Gaslini Hospital's experience
• Allowing Standing and Assisted Steps in a Patient With Renshaw Type IV Sacral Agenesis: A Case Report of a Novel Surgical Approach
• Currarino Syndrome Presenting in Adulthood: A Rare Case

The standard approach for Anterior Sacral Meningocele is through a posterior sacral laminectomy. This route permits ligation of the base, to disrupt its connection with the thecal sac and also manages tethered cord if present. A dural fibrin patch may be used to close the open defect ¹⁾.

One has to be careful to preserve nerve roots in the vicinity to prevent postoperative neurological complications.

An open anterior transperitoneal abdominal approach was used in our case as the large ASM was reaching up to the umbilicus and had a large neck. Anticipated difficulty in managing the large ASM, excellent exposure available, and previous experience of this approach guided in preferring this approach. The limitation of this procedure is the management of caudal spinal cord anomalies as deep pelvic dissection is difficult ^{2) 3)}.

Laparoscopic approach for surgical management of ASM is increasingly being used ^{4) 5)}

This is especially useful for narrow-based ASM which may be suture ligated. A posterior sagittal approach may be useful in management of ASM associated with anorectal malformations in Currarino syndrome ^{6) 7)}.

Different approaches have been described for the treatment of ASM, including the transrectal or transvaginal aspiration, dorsal transsacral approach, ventral transabdominal-transpelvic approach, inferior presacral approach, oblique parasacral approach of Demel and Coqui, lumbar-peritoneal shunt, and endoscopic approach ⁸⁾

Dorsal transsacral approach for anterior Sacral Meningocele approach