Anterior sacral meningocele misdiagnosed for an ovarian cyst

BACKGROUND Marfan syndrome is rarely accompanied by anterior sacral meningocele (ASM) resulting from erosion of the sacrum by dural ectasia. ASM may induce symptoms due to severe mass effects. ASM may also mimic ovarian cysts, and the risk of cerebrospinal fluid (CSF) leakage is high if spontaneous rupture of the cyst occurs. In this study, the authors presented a rare case of ASM with iatrogenic CSF leakage in a 34-year-old woman with suspected Marfan syndrome. OBSERVATIONS The patient initially presented with a giant ASM that was first misdiagnosed as an ovarian cyst. Previously, it had been partially resected, which was followed by iatrogenic CSF leakage. Symptoms of intracranial hypotension, including postural headache and dizziness, developed within 1 month. Brain magnetic resonance imaging (MRI) showed pituitary enlargement, bilateral subdural effusion, and tonsillar herniation. Preoperative computed tomography myelography provided three-dimensional (3D) examination of the deformed sacrum and CSF leakage site. Transabdominal approaches led to primary repair, and repair of the meningocele was achieved by intraoperative fluorescein fluorescence and 3D printed model–guided polymethyl methacrylate bone cement reconstruction. No CSF leakage or recurrent ASM was found at the 1.5-year follow-up visit. LESSONS Intraoperative intrathecal fluorescence and 3D-printed models are useful for ASM repair. Preoperative MRI is helpful for differentiating ASM from other causes of a huge pelvic mass, including ovarian cyst.

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Anterior sacral meningocele masquerading as an ovarian cyst: a rare clinical presentation associated with Marfan syndrome

Clinics and Practice ◽

10.4081/cp.2015.752 ◽

2015 ◽

Vol 5 (2) ◽

Cited By ~ 13

Author(s):

Neslin Sahin ◽

Mine Genc ◽

Esin Kasap ◽

Aynur Solak ◽

Berrin Korkut ◽

...

Keyword(s):

Marfan Syndrome ◽

Ovarian Cyst ◽

Clinical Presentation ◽

Anterior Sacral Meningocele

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Intraoperative diagnosis of an anterior sacral meningocele mimicking a giant ovarian cyst in an adult

Vojnosanitetski pregled ◽

10.2298/vsp160508364s ◽

2018 ◽

Vol 75 (8) ◽

pp. 832-835

Author(s):

Hakan Simsek

Keyword(s):

Ovarian Cyst ◽

Rare Condition ◽

Knee Extension ◽

Anterior Wall ◽

Screening Tools ◽

Pelvic Cavity ◽

Resonance Imaging ◽

Imaging Studies ◽

Dural Sac ◽

Anterior Sacral Meningocele

Introduction. Anterior sacral meningocele (ASM) is a very rare condition that is the herniation of the meningeal sac into the pelvic cavity through a developmental bone defect of the anterior wall of the sacrum. Most of the ASM are diagnosed in childhood but the reported cases that are diagnosed in adults exhibit a gamut of complications. Case report. We presented a case of ASM excision that was misdiagnosed as a giant ovarian cyst. A 28-year-old woman was admitted to the General Surgery Clinic and than to the Gynecology Department with suspect of ovarian cyst depending on ultrasonography (US) scans solely. Adnexial torsion was suspected and surgery to remove the cyst and adnexial exploration was planned. When the lesion was found out to be ASM, neurosurgery team tied the neck and excised the whole meningocele. Histopathologic evaluations confirmed dural sac. Neurological examinations right after the operation revealed 20% weakness in knee extension. It totally recovered in 6 months time. Her MR imaging studies and computed tomography (CT) scans revealed multiple ASM sacs and defects of the anterior wall of the sacrum. Conclusion. This case emphasizes the importance of utilizing available screening tools including CT andmagnetic resonance imaging (MRI) studies as the gold standard in addition to US scans in the preoperative period in order to accurately evaluate and characterize any pelvic lesion.

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