Currarino syndrome treatment
J.Sales-Llopis
Neurosurgery Service, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain.
Neurosurgeons are involved in the surgical treatment of anterior meningoceles, which are often associated with this condition 1) 2). But is not necessarily indicated, only in the rare case in which the space-occupying aspect is expected to cause constipation or problems during pregnancy or delivery. Fistulas between the spinal canal and colon have to be operated on directly 3).
Importance of early diagnosis and multidisciplinary assessment is recommended to establish adequate treatment if needed 4) 5) 6).
By accurate evaluation, the correct surgical management, including neurosurgery, can be performed in a 1-stage approach 7).
The management of Currarino syndrome is similar to the usual management of anorectal malformation (ARM) regarding the surgical approach and probably the prognosis that mainly depends on degree of associated sacral dysplasia 8).
The accepted surgical treatment is a anterior or posterior or a staged anterior-posterior resection of the presacral mass and obliteration of the anterior meningocele 9) 10).
The anterior sacral meningocele regresses over time following transdural ligation of its neck 11).
The follow-up of these patients should be done in a spina bifida clinic 12).
Posterior approach
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 13) 14).
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 15).
Anterior approach
A 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue.
Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome 16).
Video
<html><iframe width=“560” height=“315” src=“https://www.youtube.com/embed/rNqv2yGavzk” frameborder=“0” allow=“accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture” allowfullscreen></iframe> </html>