Closure of a giant anterior sacral meningocele with an omental flap in a patient with Marfan syndrome: Case report

Gabriella M. Paisan, Kenneth M. Crandall, Stephanie Chen, S. Shelby Burks, Laurence Sands, Allan D Levi

Research output: Contribution to journalArticle

Abstract

Anterior sacral meningoceles (ASMs) are rare lesions often associated with connective tissue disorders. These lesions are typically treated posteriorly via closure of the dural stalk. However, given their insidious nature, ASMs can be quite large on presentation, and this approach may not provide adequate decompression. In this case report, the authors describe the successful treatment of a large ASM through drainage and watertight closure of the cyst with an omental flap. A 43-year-old woman with a history of Marfan syndrome and a large ASM was referred for neurosurgical intervention. The ASM was filling the pelvic cavity and causing severe compression of the bladder. The patient underwent surgical decompression of the cyst through an anterior transabdominal approach and closure of the fistulous tract with a pedicled omental flap. This is the first reported case of successful closure of an ASM with an omental flap. At the 6-month followup, the ASM had not recurred on imaging and the patient's symptoms had resolved. Anterior sacral meningoceles are rare lesions that often require neurosurgical intervention. Although most can be treated posteriorly, large ASMs compressing the abdominal or pelvic organs may require a transabdominal approach. Moreover, ASMs with wide dural stalks may benefit from closure with an omental flap.

Original languageEnglish (US)
Pages (from-to)182-186
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume29
Issue number2
DOIs
StatePublished - Aug 1 2018

Keywords

  • Anterior surgery
  • Marfan syndrome
  • Meningocele
  • Surgical technique
  • Tarlov cyst

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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