Anterior sacral meningocele (ASM) is an uncommon congenital spinal abnormality in which the meningeal sac herniates through an abnormality in the anterior sacrum into the presacral space. It is more observed in females and usually asymptomatic; large ASMs may cause pressure effects on nearby pelvic structures. A 30-year-old male presented with prolonged constipation and recurrent episodes of urinary retention, which developed to complete urinary obstruction. Ultrasound demonstrated a large presacral cystic mass, and MRI confirmed the diagnosis of an ASM. Pelvic x-ray revealed the classic Scimitar Sign. Neurological examination showed no abnormalities. The patient was subjected to surgical excision through the posterior sagittal technique. Intraoperative steps consisted of laminectomy, durotomy, sac decompression, and fascial graft repairing. After the procedure, the patient experienced a smooth recovery with notable improvement in bowel and urinary symptoms. ASM is an uncommon etiology of pelvic mass and neurogenic bladder symptoms occurring in adults. This case underscores the diagnostic importance of MRI and pelvic X-ray, and also supports the posterior sagittal approach as an effective, low-complication surgical approach. ASM should be taken as a differential diagnosis for adult patients having symptoms of chronic constipation and urinary retention. Prompt imaging and surgical treatment can notably improve outcomes.

Terminal myelocystocele (TMC) is rare form of closed neural tube defect (NTD), accounting for approximately 4-8% of occult spinal dysraphisms. It is defined by cystic dilatation of the distal central canal herniating through a posterior spina bifida, typically covered by intact skin. Frequently associated with multisystem malformations, its pathogenesis remains debated, with theories involving disordered secondary neurulation, abnormal cerebrospinal fluid (CSF) dynamics, and failed disjunction between ectodermal layers. We present the case of a male neonate with a lumbosacral mass identified at birth. Magnetic resonance imaging (MRI) revealed a 50 mm TMC associated with a separate meningocele, syringomyelia, scoliosis, butterfly vertebra, and Chiari II malformation. Surgical correction at 2 weeks of age included detethering of the spinal cord, partial cyst wall resection, and dural patch closure under intraoperative neurophysiological monitoring. The postoperative course was uneventful, and at 3-month follow-up the patient remained neurologically stable with normal developmental milestones. This case underscores the clinical and radiological hallmarks of TMC, as well as the importance of early surgical intervention to prevent progressive neurological deterioration. MRI remains the diagnostic gold standard and guides surgical planning. We introduce a novel hypothesis drawing parallels with Chiari malformations, suggesting that fibrous bands and altered CSF hydrodynamics may contribute to cyst enlargement and clinical decline. A multidisciplinary approach and improved understanding of these mechanisms are crucial to optimize outcomes and refine management strategies.

Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect characterized by cystic dilatation of the meninges containing cerebrospinal fluid without the involvement of neural tissue. Neurosurgical intervention is necessary in the newborn period since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported in adulthood. Here, we discussed a case of a 23-year-old female who presented with a meningocele in the lumbosacral area since birth, which had not been operated on. Surgical management and intraoperative findings are also discussed.

Prenatal ultrasonography (USG) plays a crucial role in diagnosing fetal urinary tract anomalies and distinguishing between lower urinary tract obstructive (LUTO) and neurological causes (seen with spinal dysraphism, myelomeningocele, meningocele, and sacral agenesis) of urinary bladder distension. Fetal urinary ascites, a rare but severe complication, can result from bladder rupture associated with obstructive uropathy such as posterior urethral valves (PUV). This case study presents a rare instance of fetal urinary ascites due to PUV detected during prenatal ultrasonography at 20 weeks of gestation (WOG). By highlighting this uncommon but clinically significant condition, we aim to enhance the understanding and management of similar cases in clinical practice.

To compare cases of dysraphism with ventral tethering of cord with those with dorsal tethering and to find out any differences in the outcome of surgery in them. We collected the data of 188 consecutively operated tethered cord patients at our institute in the past 7 years and divided them into ventral tethering and dorsal tethering groups. Those that we felt had both dorsal and ventral tethering were excluded. Their preoperative clinical, radiological, and baseline neurophysiological parameters as well as postoperative clinical and radiological parameters were analyzed in a retrospective study. Among the 188 tethered cord patients, 52 (28%) had ventral tethering and 136 (72%) had posterior tethering. Preoperative neurodeficit and cord signal changes as well as absent baseline MEP (of any one muscle) were significantly more associated with ventral tethered cord than the dorsal tethered cord. The neurological deterioration after surgery occurred significantly in the ventral tethered cord group than in the dorsal tethered cord group. Also, the postoperative MRI had more incomplete detethering cases in the ventral group than in the dorsal tethered cord group. Ventral tethered cord is more likely to present with preoperatively neurological deficits. It should be carefully identified in the preoperative MRI, so that the intraoperative difficulties in complete detethering and postoperative deterioration can be anticipated.