Rare spine surgery was done at AIIMS Bhopal in the Department of Neurosurgery in a 14 years old female child, who was a resident of Bhopal (Madhya Pradesh). The procedure was done recently at AIIMS Bhopal.

The Lesion was extremely close the neuro vascular bundle.

A 14 years old female presented with recurrent abdominal pain in the Neurosurgery OPD and was admitted for complete evaluation. Mriand Ct spine was done and there was a defect in the sacrum and a large cyst was found which was pushing the rectum. There is a very little space to operate, which makes it extremely challenging to operate. Intradepartmental meeting was held by Prof. Amit Agrawal, Dr. Adesh Shrivastava, Dr Sumit Raj, Dr. Pradeep Chouksey and it was decided to operate as soon as possible. Sometime these cysts may become very large so that they present like pregnancy.

The surgery was done by Dr. Sumit Raj along with Dr Adesh Shrivastava.Patient was taken up for surgery with taking all precautions.  The patient was operated and the cyst was ligated and dural repair was done. The posterior defect was closed with a titanium mesh and screws. At the end of the procedure patient was moving her limbs and the aim of surgery was achieved. She was mobilized the next very day and discharged on the third post operative day. Sutures were removed on the 10th day in the opd.

The case was done under Intraoperative Neuromonitoring (IONM) which was done by Dr. Ruchi Singh. Anesthesia team comprised of Dr. Sunaina and Dr Rhea.

It is an extremely rare case. Such cases are done only in specialized centers. And patient did not have to pay anything extra as she was a Ayushman beneficiary.

What is anterior sacral meningocoel?

An anterior sacral meningocele is a rare form of spinal dysraphism that is sometimes associated with syndromes such as Currarino and Marfan syndromes. These lesions rarely cause neurological complications, but meningitis, sepsis, obstetric problems, and bowel and bladder difficulties are common secondary conditions. The lesions can even be fatal. Because these lesions usually do not regress spontaneously, surgical treatment is the standard for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior or posterior approaches.

Why rare?

Surgery for ant sacral meningocoel can be done both from anterior and posterior approaches. We chose posterior approach as it is direct and will cause a small scar.

The management of anterior sacral meningocele is challenging. Success depends on the coordination between Neurosurgeons, Neuro-anesthesiologist, and  a Neurophysiologist. It is a highly meticulous surgery as there is very miniscule space to operate and even a small damage can lead to weakness of the limbs and bladder and bowel symptoms may be affected.