Surgical Approaches for the Treatment of Anterior Sacral Meningocele: A Systematic Review.

Abstract

Anterior sacral meningocele (ASM) is a rare form of spinal dysraphism characterized by herniation of the dural sac through an anterior sacral defect. Clinical presentation ranges from incidental findings to compressive symptoms, infectious complications, and neurological deficits. Due to its rarity and anatomical variability, the optimal surgical management remains uncertain. A systematic review was conducted to evaluate the clinical characteristics, anatomical features, and outcomes of different treatment strategies for ASM. Searches were performed in PubMed, the Virtual Health Library, and the Cochrane Library for studies published up to 2025 in English, Portuguese, French, and Spanish. Case reports and case series describing surgically or conservatively managed ASM patients were included. Demographic, clinical, radiological, syndromic, surgical, and outcome data were extracted and analyzed using association tests, correlation analyses, and multivariate models. A total of 148 studies involving 208 patients were included. Female patients predominated (73%), with a mean age of 24.6 years. Constipation was the most common symptom (50%), followed by abdominal and low back pain. Associated malformative syndromes were identified in 66% of cases, most commonly Currarino syndrome (33%). The dorsal transsacral approach was the most frequently performed procedure (58%) and showed favorable outcomes. Combined anterior-posterior approaches demonstrated the highest success rates and no reported complications, whereas isolated abdominal endoscopic procedures were associated with higher complication rates. ASM demonstrates substantial clinical and anatomical heterogeneity, requiring individualized management. The dorsal transsacral approach appears safe and effective, while combined approaches may offer advantages in selected complex cases.