[Value of peroperative endoscopy in treating giant lumbosacral meningocele]

Lombosacral meningocele may be responsible for sciatica, low backache, cauda equina syndrome according to their localization and size. When they are symptomatic, the surgical purpose is to close the communication between the meningeal sac and the cyst. For giant meningocele, acute localization of the communication may be difficult. In such cases, peroperative endoscopy may be useful. We present a case of sciatica related to a giant meningocele extended from L2 to S2. MRI, CT scan and myelography were unable to localize the communication. We used peroperative endoscopy for direct visualization of the communication in order to minimize the surgical approach. An intrathecal nerve root was found strangulated in the communication suggesting an original kind of nerve root suffering. The communication was only closed. The patient made an uneventful recovery with complete relief of symptoms. Magnetic resonance imaging 3 months later showed a significant decrease of the meningocele without any further radicular compression.