Surgical management of anterior sacral meningoceles: a case series and systematic review
Clinical Snapshot
PICO Framework
| P — Population | Patients with anterior sacral meningoceles (ASMs), predominantly female (81%), mean age 19.4 years in case series, with 35% having associated syndromes (Marfan, Currarino) |
| I — Intervention | Three surgical approaches: anterior transabdominal (Pfannenstiel incision), posterior transsacral, and posterior sagittal (PSARP-type) |
| C — Comparator | Comparison between anterior vs posterior surgical approaches for ASM management |
| O — Outcomes | Recurrence rates, reoperation rates, sac size reduction, bladder function, complications (early/late), neurological deficits, cosmetic outcomes, mortality |
Bottom Line
This combined case series and systematic review provides valuable guidance for the surgical management of anterior sacral meningoceles, a rare form of spinal dysraphism. The evidence suggests posterior surgical approaches, particularly the PSARP-type technique, offer superior outcomes compared to anterior transabdominal approaches, with lower morbidity, better cosmetic results, and reduced recurrence rates. The study demonstrates 87.5% success in achieving sac reduction with minimal complications. However, the evidence base remains limited due to the rarity of the condition, with small patient numbers and heterogeneous study designs. While the findings support a preference for posterior approaches in most cases, reserving anterior surgery for large or high-lying lesions, clinicians should interpret these results cautiously given the methodological limitations. The work highlights the need for multicenter collaboration and standardized outcome measures in managing rare pediatric neurosurgical conditions.
Key Findings
P Value: Not reported
Effect Size: Posterior approaches preferred in 70% of literature cases with lower morbidity
Primary Outcome: Sac size reduction achieved in 87.5% of cases with no new neurological deficits
Nnt Or Sensitivity: Mortality rate 1.4% (1/68 patients) in systematic review; 87.5% success rate for sac reduction
Confidence Interval: Not reported
Clinical Application
Requires specialized pediatric neurosurgical expertise; posterior approaches technically demanding but offer superior outcomes Relevant to Australian pediatric neurosurgical centers; would align with RACS guidelines for complex spinal dysraphism management Pediatric and adult patients with anterior sacral meningoceles, particularly those with associated congenital anomalies
Abstract
PURPOSE: Anterior sacral meningoceles (ASMs) are rare forms of spinal dysraphism caused by anterior herniation of meninges through a sacral defect. Surgical management is the treatment of choice, yet the optimal approach remains debated. This study compares outcomes of three main surgical approaches-anterior transabdominal, posterior transsacral, posterior sagittal (PSARP-type)-focusing on the efficacy and safety of the PSARP-type. METHODS: A retrospective single-center analysis was conducted on eight patients treated for ASM between 2008 and 2025. Demographic, clinical, radiological, functional data were reviewed. Outcomes included recurrence, reoperation, sac size reduction, bladder function; complications were categorized as early or late. A systematic literature review was performed according to PRISMA guidelines. RESULTS: Eight patients (6 females, 2 males; mean age 19.4 years) underwent surgery (five anterior Pfannenstiel incision, two posterior sagittal, one posterior transsacral). All were symptomatic, 87.5% had associated malformations. Sac reduction was achieved in 87.5% of cases, with no new neurological deficits. Complications were mild and self-limiting, including transient urinary retention and cerebrospinal fluid fistula managed with lumboperitoneal shunt. The literature review (49 studies, 68 patients) confirmed female predominance (81%), association with Marfan and Currarino syndromes (35%), preference for posterior approaches (70%), which showed lower morbidity and recurrence rates. One postoperative death (1.4%) was reported. CONCLUSIONS: Posterior approaches-particularly the PSARP-type-provide safe, effective, and functionally favorable alternatives to anterior surgery for ASM, offering optimal exposure, precise dural closure, superior cosmetic outcomes with minimal morbidity. The anterior route should be reserved for large or high-lying lesions. Further multicenter studies with longer follow-up are warranted.
References
- 1.Sussi, G., Spezzani, C., Vitulli, F., Di Rita, A., Coletta, R., Cinalli, G., Morabito, A., & Giordano, F. (2026). Surgical management of anterior sacral meningoceles: a case series and systematic review. Child's Nervous System. https://doi.org/10.1055/s-0032-1326938
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