Anterior sacral meningocele

Case contributed by Dr Victoria Aguilar Velasco

Presentation

Claudication gait of two years of evolution, currently unable to walk. History of hysterectomy with bilateral oophorectomy secondary to an ovarian tumor.

Patient Data

Age: 50 years
Gender: Female
CT

Herniation of the dural sac into the presacral space through the anterior sacral defect with a cystic collection into the pelvis. Right posterosuperior coxofemoral dislocation. Generalized decrease in bone density. Edema of subcutaneous cellular tissue.

MRI

Anterior sacral meningocele with protrusion of some sacral nerve roots. Right coxofemoral dislocation with joint effusion and synovitis. The paravertebral muscles show fatty infiltration.

Case Discussion

Anterior sacral meningocele is an anterior sacral defect with a herniation of the meningeal sac from the sacral foramen to the retroperitoneal or presacral space. Most cases present in adulthood.

Clinically they can present with constipation, urological symptoms, or rarely neurological symptoms. The anorectal anomaly, the ventral sacral defect, and the presacral mass are collectively known as the Currarino triad. The teratoma or enteric cyst could enter this triad.

The relationship between the meningocele and the sacral nerve roots helps to establish a safe and less complicated surgical treatment.

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