Intrasacral meningocele in the pediatric population

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Intrasacral meningoceles are rare cystic lesions that can cause focal compression within the bony sacral canal. Their mechanisms are poorly understood, but most intrasacral meningoceles appear to be intrasacral extradural cysts caused by arachnoid herniating through a small dural defect in the caudal end of the thecal sac. As opposed to perineural cysts, they are not associated with an exiting nerve root. When symptomatic, they can cause sacral pain or sacral nerve root dysfunction due to local compression.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This is a retrospective series from Boston Children's Hospital. All patients in whom symptomatic intrasacral meningocele that required surgical treatment was diagnosed between May 1994 and March 2011 were included in the study. Spine MRI was the diagnostic modality of choice. All patients underwent sacral exploration, with ligation and obliteration of the cyst. Resected cyst wall was subjected to pathological examination.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 13 patients (11 boys and 2 girls) who underwent operation for intrasacral meningocele. The median age was 8 years (range 5 months–16 years). The most common presenting symptom was back pain (in 5) often described as deep tail bone pain, followed by urinary incontinence (3) and constipation (2). Three patients had evidence of associated tethered cord on MRI studies. Four patients were asymptomatic and their diagnosis was made following imaging for other reasons; they were surgically treated because of the increasing size of the lesion or association with other congenital lesions. Most patients had symptomatic improvement after surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Intrasacral meningoceles are rare lesions that may result from a congenital dural weakness and a resultant arachnoid diverticulum. They present in childhood either incidentally or with symptoms secondary to nerve root compression. Identification of the point of herniation through the dura mater and ligation of the lesion provides cyst cure and resolution of symptoms in most patients.</jats:p></jats:sec>

Unusual presentation of intrasacral meningocele: A case report and overview

“…[37] An extensive review into these lesions was carried out in 1990; this showed that 69% of patients presented with lower back pain and pain in the buttocks and legs. Nearly 56% of these patients had associated weakness in the lower limbs and 44% had altered bowel and bladder habits.…”

“…[3] Surgery is indicated when there are worsening symptoms or when imaging shows an increase in the size of the cyst. [7] Surgery for an intrasacral meningocele is performed if the child has surgery for a related spinal disorder such as cord tethering.…”

“…[12] Their mechanisms are poorly understood, but most intrasacral meningoceles are extradural cysts, which are caused by herniation of arachnoid through a dural defect at the lower end of the thecal sac. [3] The sac dilates with time and causes local erosion of the sacrum and lower lumbar vertebrae. [2] We report a case of a 12-year-old child with chronic pain diagnosed with an intrasacral meningocele identified on magnetic resonance imaging (MRI).…”

Sacral extradural arachnoid cyst in association with split cord malformation

“…Most patients harboring SEACs are asymptomatic and they are often seen as incidental asymptomatic findings in imaging examinations performed for other reasons [17,21]. Indeed, extradural meningeal cysts, especially in the sacrum, seldom cause compressive effects.…”

“…The objective of surgery, offered in symptomatic cases of SEAC, is cyst decompression and obliteration of the fistulous communication whenever possible [17]. Other surgical alternatives include cyst resection, incision and drainage, plication of the cyst, lumboperitoneal shunt placement, and simple bone decompression via a sacral laminectomy without manipulating cyst [21].…”