A. Chirianc, Giorgiana Ion, Z. Faiyad, I. Poeata DOI: 10.33962/roneuro-2020-099 Giant dorsal sacral meningocele in a child Amit Agrawal Romanian Neurosurgery (2020) XXXIV (4): pp. 577-579 DOI: 10.33962/roneuro-2020-099 www.journals.lapub.co.uk/index.php/roneurosurgery Giant dorsal sacral meningocele in a child Amit Agrawal Professor of Neurosurgery. Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, INDIA ABSTRACT Sacral meningoceles are uncommon congenital lesions, usually described in the anterior or lateral position, and they typically are asymptomatic [1,7]. A nine-years male child presented with a progressively increasing swelling over the lumbosacral region since birth. Sacral meningoceles are uncommon congenital lesions, usually described in anterior or lateral position and are typically asymptomatic.1-7 A nine year male child presented with a progressively increasing swelling over lumbo-sacral region since birth. There was no history of any bowel or bladder dysfunctions. Motor and sensory examination was normal. Planters were flexor. Rectal tone was normal. Gait was normal. Results of her sensory, rectal tone and lower limbs motor exams were within normal limits. There were no abnormal skin lesions, skeletal deformities, abnormal sinus or swellings. A physical examination of the patient showed a soft, 4 x 4-cm fluctuant and non- pulsatile mass over sacral region, completely with normal skin without any stigmata. The transillumination test was positive. Routine blood investigations were normal. Magnetic resonance imaging (MRI) of the lumbo-sacral spine showed a large, well-defined cystic over sacrum without any no evidence of internal echoes, solid component or septae (Figure-1 and 2). There was evidence of communication between the cyst and the spinal canal. The patient underwent surgical excision of the swelling and repair of the sac. The large cyst was entered and found to contain clear CSF in a terminal continuation of the spinal subarachnoid space. There was no neural tissue in the sac. And there was no evidence of tethering. Postoperatively, the child had normal neurological and urological function. CT of the brain did not show any evidence of hydrocephalus. He developed CSF leak in post-operative and the defect was repaired with pedicel graft. A meningocele a developmental defect in the dura resulting in an outpouching of leptomeninges through defect covered with only a layer of skin. 4 Most of the sacral meningoceles are asymptomatic with a soft tissue mass; they produce clinical symptoms depending on their Keywords sacral meningocele, lipomyelomeningocele. MRI, meningocele, sacral mass Corresponding author: Amit Agrawal Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India dramit_in@yahoo.com Copyright and usage. This is an Open Access article, distributed under the terms of the Creative Commons Attribution Non–Commercial No Derivatives License (https://creativecommons .org/licenses/by-nc-nd/4.0/) which permits non- commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of the Romanian Society of Neurosurgery must be obtained for commercial re-use or in order to create a derivative work. ISSN online 2344-4959 © Romanian Society of Neurosurgery First published December 2020 by London Academic Publishing www.lapub.co.uk http://www.lapub.co.uk/ 578 Amit Agrawal proximity to the spinal cord and nerve roots (e.g. unexplained radiating or low back pain, or sensory or motor deficits, atypical bowel dysfunction 1-4, 8, 9 The differential diagnosis for the mass lesions in children in sacro-coccygeal area includes meningocele, myelomeningocele, myelocystocele, teratoma, lipoma, hamartoma, lymphangioma, hemangioma, chordoma, and ependymoma. 10-15 MRI is the investigation of choice as it will better delineate the details of the sac and its contents. Also it will help to know the extent of the spinal cord and position of the nerve roots. 3 Radiographs may reveal erosion and widening in the sacral bone, 9 scalloping of the pedicles, laminae and vertebral bodies adjacent to the meningocele resulting in an enlargement of the spinal canal. 16, 17 18Indications for surgical repair include clinically symptomatic patients 1-3, 8, 19 or if the lesions located in an area where it has greater risk of mechanical trauma or rupture (as in the present case). Figure 1. MRI of the lumbo-sacral spine T1W, FLAIR and T2W sagittal images showing large, well-defined cystic lesion over sacrum (signal intensity similar to cerebrospinal fluid) without any no evidence of internal echoes, solid component or septae. Figure 2. MRI of the lumbo-sacral spine T2W axial images showing large, well-defined cystic lesion over sacrum (signal intensity similar to cerebrospinal fluid). Figure 3. Intraoperative images showing excision and repair of the meningocele. 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