Presentation
Gradually developed lower limb weakness with a recent inability to walk.
Patient Data
There is a large extra-dural cystic lesion with widening of the spinal canal opposite to S1-CC1 levels in the sacral spinal canal (with a maximum size of about 2.3 x 3.7 cm), which shows no communication with thecal sac. No nerve roots or solid components are seen in the lesion. The cystic lesion is compressing the S2, S3, S4, and S5 nerve roots. No post-contrast enhancement is noted.
Evidence of missing posterior elements (most likely congenital as there is no history of previous surgery) is seen opposite to the involved segment; however, no definite communication to the overlying posterior skin is appreciated.
Case Discussion
Current MRI findings are in favour of a sacral cystic mass lesion with the differential of a synovial cyst rather than a meningeal cyst on the provided images, as described.
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