Artikel
Surgical treatment of anterior sacral meningoceles in patients with Marfan syndrome: A new technique for anterior sacral reconstruction
Die chirurgische Behandlung von vorderen sakralen Meningozelen bei Patienten mit Marfansyndrom: Eine neue Technik zur vorderen Sakrumrekonstruktion
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Autoren
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M. Nakamura
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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J. Ebnet
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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R. Lück
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover
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H. Bektas
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover
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M. Lorenz
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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J. K. Krauss
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Anterior sacral meningoceles are a therapeutical challenge. Aim of this report is to describe a surgical technique to treat large anterior dural ectasias, which are commonly found in patients with connective tissue disorders such as Marfan syndrome. They typically occur at the caudal levels of the spine due to hydrostatic pressure of the cerebrospinal fluid and often cause complications like headaches, bowel and bladder difficulties and neurological deficits.
Methods: We describe two cases, a 22-year-old man and 24-year-old woman with Marfan syndrome associated with an anterior sacral meningocele due to dural ectasia and a bony defect of the sacrum. The first patient presented with paroxysmal headaches, low back and radicular pain refractory to analgesic treatment. The second presented with an extensive bowel herniation into the spinal canal following abdominal surgery. She suffered from low back and radicular pain, bowel and bladder dysfunction. Interdisciplinary surgery was performed via an anterior laparotomy, anterior opening of the meningocele, inward wrapping of the wall and anterior reconstruction of the sacral bony defect with titanium mesh.
Results: Both patients experienced immediate improvement of symptoms after surgery. On follow-up after 12 and 15 months, headache completely resolved in the first patient and radicular pain improved. In the second patient bowel dysfunction almost completely resolved. Low back pain and bladder dysfunction improved further. In this patient, a surgical revision was necessary through a dorsal approach with additional dural closure for a CSF fistula. There was no new postoperative deficit.
Conclusions: For surgical treatment of anterior meningoceles in patients with Marfan syndrome, anterior laparotomy in collaboration with colorectal surgeons provides an excellent exposure of the surrounding anatomical structures and enables reconstruction of the anterior sacrum to treat clinical symptoms. Wrapping the meningocele with subsequent titanium mesh covering can lead to immediate clinical improvement.
