Sato K, Hayashi M, Kawano H, Kubota T, Node M, Fujita H, Nakagawara G
Neurol Med Chir (Tokyo). 1989 Aug;29(8):753-7. doi: 10.2176/nmc.29.753.
A 53-year-old male presented with an abdominal mass and urinary disturbance. Plain pelvic X-rays revealed a scimitar deformity of the sacrum. Computed tomography (CT) of the abdomen and lumbosacral spine showed a 13 X 17 X 17 cm, hypodense, cystic mass. Metrizamide myelography disclosed a bony defect at the S2 level through which contrast material entered the pelvic cyst, confirming the diagnosis of anterior sacral meningocele. Magnetic resonance imaging demonstrated the extent of the abdominal mass and its communication with the thecal sac through the anterior sacral defect. The patient underwent surgery via the transabdominal approach. The mass was extremely adherent to the intestine and it was difficult to reach the stalk of the sac. The wall of the meningocele was resected to the extent possible, and was tightly sutured following a meningocele-peritoneal shunting procedure. Postoperatively, the patient was neurologically normal, but 4 months later he was readmitted because of headaches and clouding consciousness. CT showed bilateral chronic subdural hematomas. Following their evacuation, the patient recovered uneventfully. The clinical and neuroradiological features and the surgical approaches to anterior sacral meningoceles are discussed.
一名53岁男性因腹部肿块和尿路障碍就诊。骨盆X线平片显示骶骨呈弯刀状畸形。腹部及腰骶椎计算机断层扫描（CT）显示一个13×17×17cm的低密度囊性肿块。甲泛葡胺脊髓造影显示S2水平存在骨质缺损，造影剂通过该缺损进入盆腔囊肿，从而确诊为骶前脊膜膨出。磁共振成像显示了腹部肿块的范围及其通过骶前缺损与硬脊膜囊的连通情况。患者接受了经腹入路手术。肿块与肠道紧密粘连，难以触及脊膜膨出的蒂部。尽可能切除脊膜膨出的囊壁，并在进行脊膜膨出-腹腔分流术后紧密缝合。术后，患者神经功能正常，但4个月后因头痛和意识模糊再次入院。CT显示双侧慢性硬膜下血肿。血肿清除术后，患者顺利康复。本文讨论了骶前脊膜膨出的临床和神经放射学特征以及手术入路。
