intrasacral meningoceles are rare cystic lesions that can cause focal compression in the bony sacral canal . they are intrathecal cystic formations arising as protrusions of the arachnoid through a congenitally weak place in the dura mater . their mechanisms are poorly understood , but most intrasacral meningoceles are extradural cysts , which are caused by herniation of arachnoid through a dural defect at the lower end of the thecal sac . the sac dilates with time and causes local erosion of the sacrum and lower lumbar vertebrae . we report a case of a 12-year - old child with chronic pain diagnosed with an intrasacral meningocele identified on magnetic resonance imaging ( mri ) . a 12-year - old child presented to the hospital with a 2-month history of bilateral knee and ankle pains associated with muscle weakness , needing wheelchair and crutches . he had no history suggestive of any bladder or bowel involvement and did not complain of any sensory disturbances . he had presented with flu - like symptoms before onset of these symptoms and was discharged home on painkillers . his power was grade 4/5 in both lower limbs with no evidence of any spinal tenderness . his blood showed normal inflammatory markers with vitamin d deficiency , which was treated with high - dose vitamin d supplements . he had multidisciplinary input involving the pediatric physiotherapists , occupational therapists , and psychologists with good improvement in his symptoms . the term  intrasacral meningocele  was introduced by enderle in 1932 . it was used to describe a sac of fibrous tissue similar to dura mater , which lied within an enlarged sacral spinal canal . this sac was attached to the lower end of the dural sac by a pedicle that usually allowed the cerebrospinal fluid to flow from the subarachnoid space into the meningocele . in 1988 , nabors et al . classified spinal meningocele cysts into three categories : type i which were extradural cysts without any spinal nerve root fibers ; type ii which described extradural cysts with spinal nerve root fibers ; and type iii which were intradural cysts . intrasacral meningoceles would therefore be classified as type i spinal meningocele as per the above classification . patients with intrasacral meningoceles usually present with pain and alteration in their bowel and bladder habits . an extensive review into these lesions was carried out in 1990 ; this showed that 69% of patients presented with lower back pain and pain in the buttocks and legs . nearly 56% of these patients had associated weakness in the lower limbs and 44% had altered bowel and bladder habits . . mri scan of intrasacral meningocele shows an extradural cyst with smooth contours present in the sacral spinal canal with no neural elements noted inside the cyst . surgical treatment is not always the most appropriate mode of management in a patient with intrasacral meningocele . surgery is indicated when there are worsening symptoms or when imaging shows an increase in the size of the cyst . surgery for an intrasacral meningocele is performed if the child has surgery for a related spinal disorder such as cord tethering . surgical ligation and obliteration of the cyst is the procedure of choice to treat this disorder . intrasacral meningoceles are rare lesions that may result from a congenital dural weakness leading to protrusion of the arachnoid . they may present in childhood with symptoms such as low back pain and bowel and bladder symptoms or may be detected incidentally . we recommend that all children with chronic back and lower limb pain should have mri of the spine to rule out occult intrasacral meningoceles .
intrasacral meningocele is an unusual congenital lesion . 
 it is an intrathecal cystic formation arising as a protrusion of the arachnoid through a congenitally weak place in the dura mater . 
 we report a case of a 12-year - old child with chronic pain with an intrasacral meningocele identified on magnetic resonance imaging .