Anterior sacral meningocele asm is a rare congenital anomaly which was first described in 1837 by bryant. Surveillance, epidemiology and end result program nseer. Janinis j, mctiernan a, driver d, mitchell c, cassoni am, pringle j, et al. Ct or mri is the best imaging method to confirm the diagnosis. Anterior sacral meningocele infected with fusobacterium in a patient with recently diagnosed colorectal carcinoma a case report anne k. F ig 2 axial ct image a, 3d view generated from the ct images b, axial t1 and t2weighted images c and d, sagittal t1 and t2weighted images e and f clearly demonstrate multiple segmentation anomalies and a large anterior meningocele herniating through a bone defect at the level of t7t10 vertebrae. We describe how the anterior meningocele affected the imaging workup. They are typically categorized into congenital, iatrogenic e.
Prenatal diagnosis of anterior sacral meningocele sumi. Anterior sacral meningocele is a unilocular or multilocular extension or herniation of the dura mater and arachnoid out of the sacral spinal canal through a defect in the sacrum into the retroperitoneum and infraperitoneal space, either anteriorly through the body of the. Anterior sacral meningocele discovered by whole body. Matson noted only three examples in his analysis of 90 cases of spina bifida cystica. Anterior sacral meningocele asm is a rare form of spinal dysraphism in children. It is believed that mr imaging is the most useful preoperative diagnostic technique available in establishing a treatment plan for anterior sacral meningocele. The anterior sacral meningocele may be isolated or may be associated with other congenital abnormalities. The role of mr imaging in the diagnosis and treatment of.
This article discusses various protocols for plainfilm and ct imaging. An intrasacral meningocele is a rare form of sacral cyst that was first reported in 1932 by enderle. Meningoceles are protrusions of the meninges through a defect or weak point in the skull or spine, usually involving the soft tissues beneath the surface of the skin. We describe a patient suffering from low back pain and radicular symptoms, in whom multimodality radiological examinations showed an intrasacral meningocele and a lumbar disc prolapse. Anterior sacral meningoceles are rare, and usually occur with other. Management of occult intrasacral meningocele associated. Imaging the sacrum and coccyx imaging of the sacrum and coccyx is a common procedure in radiology. Expanding upon the core of the highly popular second edition, this updated reference is fully revised to provide the best spinerelated diagnostic support available. Jan 01, 20 an 8monthold boy presented with high fever with seizures and weakness of legs. This sac is composed of outer dural tissue and inner arachnoid membrane.
Transabdominal excision is probably the best treatment. Herniation of the meningeal sac into the extra peritoneal pelvic region through a congenital defect in the sacrum 1. Clinical presentation, differential diagnosis, diagnostic modalities and management. Magnetic resonance imaging is very useful for diagnosing congenital disorders like meningocele, sacral agenesis, and other congenital lesions. Anterior sacral meningocele asm is a rare disorder with a congenital or acquired etiology. Occult intrasacral meningocele is an uncommon condition that may produce chronic low back pain, sciatica, and bladder dysfunction. Anterior sacral meningocele is characterized by herniation of the meningeal sac due to a developmental bone defect in the front of a sacrum bone.
Preoperative sagittal a and axial b t2weighted images of lumbosacral. A diagnosis of anterior sacral meningocele asm was made, and the surgical team was informed of its coexistence with the postoperative pelvic collections. Expanding upon the core of the highly popular second edition, this updated reference is fully revised to provide. Anterior sacral meningocele associated with tethered cord. These cases show mr to be a reliable technique in the initial evaluation of these disorders. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. In this form, herniation of the meninges in a cystlike formation is seen from birth. Most of the symptoms are due to compression on the.
The role of mr imaging in the diagnosis and treatment of anterior sacral meningocele report of two cases k. Sacral defect with anterior meningocele how is sacral. Summary anterior sacral meningocele is a rare, dysraphic disorder that is most frequent in females, principally in the child bearing years. Conservative management is an appropriate option for small, asymptomatic anterior spinal meningocele. A new procedure was carried out to drain the collections, care being taken to avoid the sacculation caused by the asm, which was visible and palpable. No solid or calcified elements appeared within the masses. Differential diagnosis of anterior sacral meningocele during. An 8monthold boy presented with high fever with seizures and weakness of legs. Pdf anterior sacral meningocele is characterized by the herniation of the thecal sac into the. Puvaneswary, mbbs, frcr lecturer departmentofradiology faculty omedicine universiti ofmalaya, 59100 kuala lumpur. This is not usually a diagnosis made prenatally, indeed it often presents in adult females as a mass found coincidentally on ultrasound. This article presents an imaging approach to retrorectalpresacral masses with. Isolated true anterior thoracic meningocele american journal of.
He was managed by surgery through posterior approach along with antibiotics. Magnetic resonance imaging is the investigation of choice. At magnetic resonance imaging, it was demonstrated that the cystic mass made an impression. Congenital spinal meningocele radiology reference article. Pathophysiology, diagnosis, and treatment of spinal. The meningocele is at a close neighborhood of the right main bronchus, the main. Extensive imaging including spinal magnetic resonance imaging mri, lumbar mri. Diastematomyelia of the thoracic spinal cord diagnostic. An asymptomatic large anterior sacral meningocele in a patient. Anterior sacral meningocele, pelvic cyst, tethered cord, mri, ultrasonography.
Heres the complete overview of imaging in spine surgery 1st edition pdf. Download imaging in spine surgery 1st edition pdf free. This may not be the complete list of references from this article. Upon these imaging findings, the patient got the diagnosis of an anterior sacral meningocele. Myelomeningocele, also known as spina bifida cystica, is a complex congenital spinal anomaly that results in spinal cord malformation myelodysplasia. The possibility of an anterior sacral meningocele must always be kept in mind in the differential. Anterior sacral meningocele asm is an exceedingly rare condition, which may be asymptomatic presenting late in life or present early with symptoms due to compression effect over the surrounding pelvic viscera. Anterior sacral meningocele with spinal epidural abscess. Sacral defect with anterior meningocele listed as sdam. Spina bifida is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy.
An anterior sacral mass with an associated sacral defect when present with an anorectal anomaly is known as currarinos triad 5. The congenital anterior sacral meningocele asm was first described by bryant in 1837. High index of suspicion with careful clinical examination is necessary to make early diagnosis. The estimated incidence of spinal dysraphism is about live births. The anterior sacral meningocele is an anterior sacral defect or a herniation of the meningeal sac from the sacral foramen to the anterior.
Mar 03, 2016 trauma relating to the sacrum may well be associated with other injury to the pelvic ring and imaging of the pelvis is likely to be required in addition to examination of the sacrum. Imaging is critical, but a detailed medical history carefully taken by medical service providers can prompt important clues. Asm is an anomaly associated with various degrees of sacral bone agenesis allowing the herniation of a csffilled meningeal sack into the pre sacral pelvic space 2. Another rare form of meningocele is the non dysraphic meningocele, charac terized by the absence of a congenital defect of the vertebrae. Summary anterior sacral meningocele is a rare congenital meningeal cyst herniating through a bony defect in the sacrum. It is defined as a meningeal cyst that occurs in the presacral space secondary to agenesis of a portion of the anterior sacrum. Anterior sacral meningocele may be the cause of tethered cord syndrome. With the presentation of a case of giant anterior sacral meningocele, the evident superiority of magnetic resonance imaging over any other methods for the diagnosis of. Usually asymptomatic, it can present as constipation, urinary problems or rarely neurological symptoms. Differential diagnosis the differential diagnosis includes diplomyelia, tethered spinal cord, thickened filum terminale, neurenteric cysts, congenital dermal sinus tract, anterior sacral meningocele, spinal lipomas, and dermoid and epidermoid tumors. Anterior sacral meningocele mimicking bladder neck rupture. On pelvic radiographs, a unilateral anterior sacral defect may be seen with a.
As a conclusion, anterior sacral meningoceles are rare and can easily be mistaken for the bladder. Pdf anterior sacral meningocele mimicking ovarian cyst. Anterior sacral meningocele containing large dermoid cyst. Treatment of a sacral fracture associated with an intrasacral. It is usually discovered during a rectal or pelvic examination as a cystic lesion or discovered incidentally. A narrow stalk connecting the pelvic cyst and the spinal canal through the anterior sacral foramen was clearly delineated in the t2. Spine, now in its third edition, showcases the latest cuttingedge research from dr. Maternal anterior sacral meningocele in pregnancy pubmed. Diastematomyelia of the thoracic spinal cord with associated vertebral body fusion.
The role of mr imaging in the diagnosis and treat ment of anterior sacral meningocele. Currarino syndrome and the effect of a large anterior. Cerebrospinal fluid analysis revealed acute pyogenic meningitis and magnetic resonance imaging revealed anterior sacral meningocele with epidural abscess. Spinal dysraphism refers to the entire range of spinal column and neuraxis anomalies. Laparoscopic treatment of anterior sacral meningocele by. Anterior sacral meningocele is a congenital anomaly characterized by agenesis of a part of the anterior portion of the sacrum, herniation of meninges through the defect, and formation of. Recent advances in the diagnosis and treatment of presacral. It is also referred to as a tarlov cyst and it is an anterior herniation of meninges only into the pelvis. The most common location is the lower back, but in rare cases it may be in the middle back or neck. Magnetic resonance imaging mri revealed basal meningocele due to. Isolated true anterior thoracic meningocele american.
An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44yearold woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Covering the entire spectrum of this fastchanging field, diagnostic imaging. In this case, the large meningocele and distorted bladder made visualization impossible. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Mr imaging in children with clinically andor radiographically suspected spinal. Anterior sacral meningocele associated with hemisacral dysgenesis were described also as subtype of caudal dysgenesis, a rare syndrome occurring in 0. Meningocele is one of the variants of spina bifida, a neural tube defect demarcating incomplete closure of the spinal cord. Signs of occulta may include a hairy patch, dimple, dark spot, or swelling on the back at the site of the gap in the spine. Imaging of presacral massesa multidisciplinary approach europe. The management of anterior sacral meningocele with computed. Welch and aterman 1984 gave a population frequency of 0. Anterior sacral meningocele occult intrasacral meningocele sacrococcygeal teratoma. This paper discusses the indications for spinal ultrasound, including its advantages and disadvantages compared. We reported a case of asm associated with neurofibromatosis, which was mimicking a complex ovarian cyst in ultrasonography.
Anterior sacral meningocele asm is a very rare condition that is the herniation of the meningeal sac into the pelvic cavity through a developmental bone defect of the anterior wall. Case summary a 2yearold boy with a history of a complex anorectal malformation arm consisting. Posterior sagittal approach for currarino syndrome with. Pediatric neuroradiology, third edition, is an invaluable resource for radiologists, child neurologists, and pediatriciansanyone who requires an easily accessible reference that covers common and uncommon disorders affecting the brain, head, neck, and spine of children. We present a laparoscopic approach as an adjunctive approach. Akb received funding the start program of the medical faculty of. Sacral defect with anterior meningocele sdam is a form of caudal dysgenesis. Anterior sacral meningocele is a unilocular or multilocular extension of the dura mater and arachnoid out of the sacral spinal canal into the retroperitoneal and infraperitoneal space, either anteriorly through the body of the sacrum or anterolaterally through an enlarged intervertebral foramen or coalesced foramina. Anterior sacral meningocele infected with fusobacterium in a patient. Case report year old male with a history of a complex anorectal ctourethral fistula and a large anterior sacral meningocele was initially treated with a doublebarrel colostomy at another institution. Myelomeningocele, also known as open spina bifida, is the most severe form. Anterior spinal meningocele is a kind of rarely encountered malformation with the unclarified mechanism of pathogenesis. Association of syringomyelia with lower urinary tract dysfunction in anterior sacral meningocele with a tethered spinal cord. Sacral defect with anterior meningocele conditions gtr.
Rectal examination and radiography of the pelvis with the sacral bone showing the scimitar sign are the main diagnostic methods. The possibility of an anterior sacral meningocele must always be kept in mind in the differential diagnosis of a pelvic cystic mass. Asm is an anomaly associated with various degrees of sacral bone agenesis allowing the herniation of a csffilled meningeal sack into the presacral pelvic space 2. Epidemiology it is one of the commonest congenital cns anomalies and thought to occur in ap. Meningocele typically causes mild problems with a sac of fluid present at the gap in the spine. Anterior sacral meningocele is an unusual anomaly consisting of a spinal fluidfilled sac in the pelvis which communicates via a narrow neck with the spinal subarachnoid space. One such case was seen in a baby girl aged 2 months, who was admitted with abdominal distension and urinary difficulty for one week. The congenital form of the sacral anomaly can vary from minor sacral defects to complete sacral agenesis. Anterior sacral meningocele contiguous with a pelvic hamar toma. We report the imaging findings of a patient with an isolated anterior. There are 3 terms under the parent term meningocele in the icd10cm alphabetical index. General imaging differential considerations include.
Accordingly, we reached the prenatal diagnosis of anterior sacral meningocele. This article is either under construction or in the approval process. Anterior sacral meningocele radiology reference article. The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes.
Anterior sacral meningocele presenting as constipation. A spinal meningocele is a herniation of the meninges through a. Congenital spinal meningoceles are developmental anomalies of meningothelial elements displaced into the skin and subcutaneous tissues. Please refer to the meningocele article for a broad overview of all types of this condition. The cause includes genetic and environmental factors, such as obesity and poor nutrition. The structures communicated at multiple levels with the sacral dural sac, projecting into the retroperitoneal space through the anterior sacral foramina figures 3 and 4. A case report by noriaki otagiri, yutaro matsumoto, and yasuko yoshida iwaki, japan the authors report a case of currarino syndrome with anterior sacral meningocele, tethered cord, and anorectal stenosis that was treated by posterior sagittal approach.
Information for this case report was gathered from patient notes and imaging from the patient chart. We report the case of a 31 yearold pregnant woman with an anterior sacral meningocele. Marfan syndrome anterior sacral meningocele was reported to be associated in 21% of the cases compared to around 200 cases among the general population28. Sagittal ultrasound image of the pelvic area showing a thinwalled cystic lesion compressing the uterus on the posterior. Posterior sagittal approach for currarino syndrome with anterior sacral meningocele.
Pdf anterior sacral meningoceles asms are rare defects in the sacrum with. Anterior sacral meningocele d samuel, mbbs, dmrd lecturer m. Cerebrospinal fluid analysis confirmed bacterial meningitis and a spinal magnetic resonance imaging scan revealed a dermal sinus tract with an anterior spinal meningocele, caudal regression syndrome, and a tethered spinal cord. We classified them into three types, namely caudal, paraneural, and nerveroot types based on the anatomy and relationship between the cyst and sacral nerve roots. Association of syringomyelia with lower urinary tract. Anterior sacral meningocele infected with fusobacterium in. The sacral meningocele may be congenital or acquired. The bladder appeared vertical and its neck elongated. Pdf anterior sacral meningocele associated with tethered cord. Unusual presentation of an anterior sacral meningocele. Successful management of a giant anterior sacral meningocele with.
Currarino syndrome and the effect of a large anterior sacral meningocele on distal colostogram in an anorectal malformation. From the departments of urology, university of vermont. In this paper, we present an anterior sacral meningocele mimicking the bladder. Anterior sacral meningocele asm is a rare congenital anomaly, characterized by herniation through a defect in the anterior aspect of the sacrum. Individualized management of giant anterior meningoceles. This report concerns a case of anterior sacral meningocele asm with an evaluation of the diagnostic reliability of the ct scan for the management of this condition and others concerning the vertebral column and pelvis. The images from this study showed a large anterior sacral meningocele displacing the bladder anteriorly, superiorly, and towards the right side of the pelvis.
Anterior sacral meningocele asm is a rare congenital abnormality affecting 1 in 40. Anterior sacral meningocele is a congenital defect seen in the anterior aspect of the spine. This is a case of a 46yearold woman who presented with urinary incontinence, early satiety, and back pain in the setting of a known anterior sacral meningocele. Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. We describe the role of magnetic resonance imaging in the evaluation.
It is present at birth and becomes symptomatic later in life, usually because of obstructive labor in females, chronic constipation, or meningitis. Oct 01, 2007 laparoscopic treatment of anterior sacral meningocele published on oct 1, 2007 anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. Posterior surgical approach with ligation of the narrow communication between the sacral dural sac and the meningocele alleviated the subjective complaints of a feeling of abdominal distention and of dysuria. A diagnosis of bilateral anterior sacral meningocele asm was made. An anterior spinal meningocele is rare and is generally described in the thoracic or sacral region. A case of anterior sacral meningocele which was clearly visualized on whole body computerized tomography is presented. Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. Anterior sacral meningocele in association with marfans. These are usually located in the anterior thoracic level and are frequently. An asymptomatic large anterior sacral meningocele in a.
Anterior sacral meningocele is a congenital anomaly characterized by agenesis of a part of the anterior portion of the sacrum, herniation of meninges through the defect, and formation of a hernial sac in the pelvis. Anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. The sac contains cerebrospinal fluid with no neural elements. Anterior sacral meningocele associated with marfans syndrome is regarded as dural ectasia resulting from the basic connective tissue weakness. In cases of severe trauma it is inadvisable to undertake a lateral projection of the sacral area in the position described in this section.
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