PMC7265423_01
Photograph of the patient in the prone position, note the fistula posterior to the anus, and a drop of watery liquid.
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F1
On examination, she had a fistula posterior to the anus through which a drop of clear watery liquid extruded utilizing a Valsalva maneuver [Figure 1].
Radiograph of the sacrum, AP view shows the scimitar defect on the left side.
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F2
On pelvic radiography, a scimitar defect was observed involving the left caudal side of the sacrum [Figure 2].
Reconstructed 3D CT shows the scimitar defect more clearly.
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F3
The lumbosacral 3D computerized tomography (CT) showed the scimitar defect more clearly [Figure 3].
Sagittal T2-weighted MR image demonstrates a cystic mass in presacral region, note an extension of the cyst toward the anorectal region. (white arrow).
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F4
T1 and hyperintense on T2-weighted images; these findings were compatible with an ASM [Figure 4]. The lumbosacral CT metrizamide myelogram confirmed communication between the presacral cyst and the thecal sac.
CT metrizamide myelography shows the cyst and its extension to the anorectal region.
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F5
Further extension of the meningocele toward the anal region was also suspected [Figure 5].
(a) Intraoperative photograph showing reconstruction of the sacrum with mini plate, (b) postoperative sacral X-ray ap view shows the reconstructed sacrum with mini plates.
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F6
The bony defect was covered with the bone flap and affixed with mini plates [Figure 6].
Postoperative sagittal 2-weighted MRI 10 years after surgery, no cystic mass anymore, note the posterior aspect of the sacrum indicating mini plates.
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F7
The MRI also confirmed the complete resolution of the previously noted meningocele/fistula [Figure 7].