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. 2013 Oct;8(4):174-8.
doi: 10.4103/1793-5482.125660.

Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele

Rajiv Azad  1 , Sheenam Azad  2 , Ashish K Shukla  1 , Pankaj Arora  3
Affiliations

Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele

Rajiv Azad et al. Asian J Neurosurg. 2013 Oct.

Abstract

Objective: We evaluated the role of screening of the whole spine by sagittal magnetic resonance imaging (MRI) along with MR myelography in early detection and management of occult intrasacral meningocele.

Materials and methods: A prospective and retrospective analysis of MRI and MR myelography studies of the whole spine over a period of one year was performed.

Results: Thirty cases with sacral meningeal cysts were seen. On MRI, six patients (three males, three females) fulfilled the criterion of occult intrasacral meningocele. These patients showed a cyst of cerebrospinal fluid (CSF) signal intensity in the sacral canal below the dural sac. This cyst communicated with the thecal sac through a narrow pedicle. Fat signal intensity in the filum terminale and occult sacral dysraphism in the form of an absent or hypoplastic neural arch was observed in all the patients. Low-lying conus medullaris with thick filum terminale was seen in five of these six patients. Excision of the cyst with the release of filum was performed in two patients with a favorable outcome.

Conclusion: Screening MRI with MR myelography of the whole spine may play a role in the early detection and management of occult intrasacral meningocele. The commonly associated thick filum terminale and low-lying conus medullaris may be missed otherwise that may lead to a progression of symptoms.

Keywords: MR; myelography; occult meningocele.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Screening sagittal whole-spine magnetic resonance myelography shows the sacral meningeal cyst
Figure 2
Figure 2
(a-d) Sagittal and axial MR (T1-weighted (a, c, d)) and T2-weighted (b) images show a low-lying conus medullaris terminating at the L3-L4 level. Thick fatty filum terminale appears hyperintense (↑) on T1 (a, c) and is adherent to a large intrasacral cyst at the S3-S4 level. Absent neural arches are seen on axial T1 images (c, d)
Figure 3
Figure 3
(a-e) (a) Sagittal MR myelography (b) T2-weighted (c) T1-weighted (d) gradient diffusion and (e) axial T1-weighted (d) images show a large biloculated cystic lesion in the sacrum. The upper locule exhibits cerebrospinal fluid signal intensity, whereas the lower locule displays hyperintense signal on gradient diffusion imaging. Neurogenic bladder (↑) is also noted
See this image and copyright information in PMC

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