case_images: PMC7265423_01
case_images: Photograph of the patient in the prone position, note the fistula posterior to the anus, and a drop of watery liquid.
case_images: SNI-11-117-g001.jpg
case_images: PMC7265423_01_SNI-11-117-g001.jpg
case_images: F1
case_images: On examination, she had a fistula posterior to the anus through which a drop of clear watery liquid extruded utilizing a Valsalva maneuver [Figure 1].
case_images: Radiograph of the sacrum, AP view shows the scimitar defect on the left side.
case_images: SNI-11-117-g002.jpg
case_images: PMC7265423_01_SNI-11-117-g002.jpg
case_images: F2
case_images: On pelvic radiography, a scimitar defect was observed involving the left caudal side of the sacrum [Figure 2].
case_images: Reconstructed 3D CT shows the scimitar defect more clearly.
case_images: SNI-11-117-g003.jpg
case_images: PMC7265423_01_SNI-11-117-g003.jpg
case_images: F3
case_images: The lumbosacral 3D computerized tomography (CT) showed the scimitar defect more clearly [Figure 3].
case_images: Sagittal T2-weighted MR image demonstrates a cystic mass in presacral region, note an extension of the cyst toward the anorectal region. (white arrow).
case_images: SNI-11-117-g004.jpg
case_images: PMC7265423_01_SNI-11-117-g004.jpg
case_images: F4
case_images: T1 and hyperintense on T2-weighted images; these findings were compatible with an ASM [Figure 4]. The lumbosacral CT metrizamide myelogram confirmed communication between the presacral cyst and the thecal sac.
case_images: CT metrizamide myelography shows the cyst and its extension to the anorectal region.
case_images: SNI-11-117-g005.jpg
case_images: PMC7265423_01_SNI-11-117-g005.jpg
case_images: F5
case_images: Further extension of the meningocele toward the anal region was also suspected [Figure 5].
case_images: (a) Intraoperative photograph showing reconstruction of the sacrum with mini plate, (b) postoperative sacral X-ray ap view shows the reconstructed sacrum with mini plates.
case_images: SNI-11-117-g006.jpg
case_images: PMC7265423_01_SNI-11-117-g006.jpg
case_images: F6
case_images: The bony defect was covered with the bone flap and affixed with mini plates [Figure 6].
case_images: Postoperative sagittal 2-weighted MRI 10 years after surgery, no cystic mass anymore, note the posterior aspect of the sacrum indicating mini plates.
case_images: SNI-11-117-g007.jpg
case_images: PMC7265423_01_SNI-11-117-g007.jpg
case_images: F7
case_images: The MRI also confirmed the complete resolution of the previously noted meningocele/fistula [Figure 7].