Paisan Gabriella M, Crandall Kenneth M, Chen Stephanie, Burks S Shelby, Sands Laurence R, Levi Allan D
1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
2Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida; and.
J Neurosurg Spine. 2018 Aug;29(2):182-186. doi: 10.3171/2018.1.SPINE171303. Epub 2018 May 25.
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 follow-up, 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.
骶前脑脊膜膨出（ASMs）是一种罕见的病变，常与结缔组织疾病相关。这些病变通常通过封闭硬脊膜蒂从后方进行治疗。然而，鉴于其隐匿性，ASMs在就诊时可能已经很大，这种方法可能无法提供充分的减压。在本病例报告中，作者描述了通过用网膜瓣引流并严密闭合囊肿成功治疗巨大ASMs的过程。一名有马凡综合征病史且患有巨大ASMs的43岁女性被转诊接受神经外科干预。该ASMs充满盆腔并导致膀胱严重受压。患者通过经腹前路进行囊肿减压，并使用带蒂网膜瓣闭合瘘管。这是首例报道用网膜瓣成功闭合ASMs的病例。在6个月的随访中，影像学检查显示ASMs未复发，患者症状已缓解。骶前脑脊膜膨出是罕见病变，通常需要神经外科干预。虽然大多数可以从后方治疗，但压迫腹部或盆腔器官的巨大ASMs可能需要经腹入路。此外，硬脊膜蒂较宽的ASMs可能受益于用网膜瓣闭合。
