PMC8492421_01
(a) Head computed tomography (CT) shows pneumocephalus in the posterior fossa (*). (b) T2-weighted sacral sagittal magnetic resonance imaging (MRI) revealed an anterior sacral meningocele (ASM) (#). (c) Contrast T1-weighted sacral sagittal MRI revealed an ASM whose caudal pole (#) was in contact with the recurrent pilonidal cyst (PC) (*). (d) Clear liquid (#) draining from the PC (*), increasing with Valsalva maneuver. (e) Sacral sagittal CT showed spina bifida (*) and the agenesis of a portion of the anterior sacrum (#).
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F1
The head computed tomography (CT) obtained in ED showed pneumocephalus in the posterior fossa [Figure 1a]. A spine magnetic resonance imaging (MRI) revealed an ASM [Figure 1b] whose caudal pole was in contact with the recurrent PC [Figure 1c]. Close inspection of the PC showed clear liquid draining spontaneously, increasing with Valsalva maneuver [Figure 1d]. Sacral CT showed spina bifida and the agenesis of a portion of the anterior sacrum [Figure 1e].
Intraoperative view showing (a) the first dural flap (*) suture over the spinal canal dura and (b) the second flap (*) sutured in a watertight fashion over the first flap. (c) Follow-up T2-weighted sagittal sacral magnetic resonance imaging confirmed the total closure of the anterior sacral meningocele (*).
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F2
The dural flap was sutured in watertight fashion to the spinal canal dura [Figure 2a]. A second flap was harvested from the meningocele, based in the cranial aspect of the anterior sacral defect and sutured in a watertight fashion over the first flap [Figure 2b]. The follow-up spine MRI confirmed the total closure of the ASM [Figure 2c].