Association of syringomyelia with lower urinary tract dysfunction in anterior sacral meningocele with a tethered spinal cord: A case report and literature summary

Giant anterior sacral meningocele associated with hydroureteronephrosis and renal injury: illustrative case

“…The main etiology is congenital, but it can be acquired as a result of dural ectasia, usually associated with specific causes such as Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis types I and II, or anterior sacral trauma. [1][2][3] The first description of congenital ASM was published in 1837 by Thomas Bryant, and there are currently just over 250 cases published in the medical literature. The clinical presentation can vary from asymptomatic to the presence of nonspecific symptoms and signs such as constipation, dysmenorrhea, dyspareunia, urinary retention, urinary incontinence, dysuria, polyuria, radiculopathy, and/or paresthesia related to genitourinary, neurological, reproductive, or colorectal dysfunction due to mass effect on the abdominal viscera.…”

“…There is also an association between this dysraphism and congenital abnormalities such as anorectal malformations, sacrococcygeal teratoma, uterine duplication, lipoma, and dermoid and epidermoid cysts. [1][2][3] Magnetic resonance imaging (MRI) is the gold standard test for diagnosing this defect because it is able to assess the communication between the pedicle and the lesion, spinal cord anchorage, and the presence of associated neoplasms. Computed tomography (CT) and lumbosacral radiography can be complementary for better visualization and identification of bone lesions.…”

“…Computed tomography (CT) and lumbosacral radiography can be complementary for better visualization and identification of bone lesions. 1,2 Because of the lack of spontaneous regression of the sacral meningocele, surgery is the treatment of choice for therapeutic resolution. Surgical approaches can be performed laparoscopically or endoscopically or from a posterior sacral access.…”

“…The goal of treatment is to eliminate communication between the meningocele and the spinal subarachnoid space. 1,2,4 Illustrative Case A 24-year-old woman diagnosed with Marfan's syndrome presented to our institution with polyuria, recurrent urinary tract infections, and increased nitrogenous waste (creatinine 2.1 mg/dL, urea 82 mg/dL, and creatinine clearance 42.39 mL/min) for 3 months with progressive worsening of urinary symptoms. During diagnostic investigation, an abdominal cystic lesion extending from the intraspinal canal at the sacral level was found, and the patient was referred for neurosurgical evaluation and management.…”

“…2). 1,2 Surgical Technique Before surgical procedure, the patient underwent a lumbar puncture, receiving 2 mL of fluorescein for better intraoperative visualization of the spinal defect. The surgical approach used the Cherney incision, consisting of an incision 2 to 3 cm above the pubic symphysis that gave access to the retropubic space, with identification of an extensive cystic lesion with compressive effect on the uterus, the bladder, and the intestines after opening the parietal peritoneum.…”