[Surgical indications in ventral sacral meningocele]

Area of Science:

• Neurology
• Pediatric Surgery
• Developmental Biology

Background:

• Sacral ventral meningoceles are rare spinal malformations.
• They likely stem from dysraphic disorders during early embryogenesis, related to spina bifida.
• These malformations involve a ventral defect extending towards the sacrum.

Observation:

• A case of a 4-year-old girl with an extensive sacral ventral meningocele causing urinary tract and rectal obstruction, and peroneal muscle paralysis.
• Three adult cases with smaller, asymptomatic sacral ventral meningoceles discovered during myelography for lumbar ischialgia.
• No correlation was found between neurologic symptoms and the smaller meningoceles in adults.

Findings:

• Surgical reduction of the large pelvic meningocele in the child led to significant postoperative improvement.
• Two adult patients with lumbar ischialgia improved after discectomy; one improved with conservative treatment.
• Surgical removal of sacral ventral meningoceles is indicated when they present as space-occupying pelvic tumors.

Implications:

• Surgical decompression from the cerebrospinal fluid (CSF) space can effectively relieve urinary and rectal obstruction caused by large meningoceles.
• Early diagnosis and surgical management are crucial for pediatric cases with significant mass effect.
• The study highlights the variable clinical presentation and management strategies for sacral ventral meningoceles in different age groups.