Successful operative management of giant anterior sacral meningocele via trans-abdominal approach in an adult male

Abstract

Anterior sacral meningocele is a rare congenital anomaly encountered in neurosurgical practice. In all, approximately 200 cases of this rare congenital malformation have been reported till date. Surgical management has been accepted beyond doubt as the treatment of choice and posterior surgical approach has been adopted in majority of the cases, however there are no concrete guidelines for choosing anterior or posterior approach. The authors report here an unusual presentation of a giant anterior sacral meningocele in an adult. A 30 year old male, presented with persistent constipation and urinary retention. On evaluation, a giant anterior sacral meningocele of size 13x10x13cm was seen on imaging causing significant compression of the rectum and bladder. A single stage surgery was planned via trans-abdominal approach. Successful excision of the meningocele sac was done along with dural repair, thus relieving the patient of his symptoms. The authors reflect on the cases reported in literature and the approaches used by other surgeons. The authors also discuss in this paper, the reasons for choosing the anterior approach in such rare cases and their observations during the intra and post-operative course. The authors conclude by enumerating the advantages of the anterior approach while also suggesting key operative steps to prevent complications.

Keywords

• Anterior sacral meningocele
• Adult
• Single stage
• Transabdominal approach