Giant Anterior Sacral Meningocele in an Adult with Currarino Syndrome: Multidisciplinary Neurosurgical–Anesthetic Management

Abstract Currarino syndrome is a rare congenital triad comprising anorectal malformation, sacral bone defect, and presacral mass. Anterior sacral meningocele (ASM)—the most surgically complex component—communicates directly with the subarachnoid space, creating unique anesthetic and neurosurgical challenges. Reports on structured preanesthetic assessment and combined multidisciplinary management in the adult female with Currarino syndrome are scarce in the Indian literature. A 26-year-old woman with a known history of anorectal malformation and prior colostomy/anoplasty presented to our neurosurgery department, with an incidentally detected large pelvic cystic lesion. Contrast-enhanced magnetic resonance imaging of the pelvis confirmed Currarino syndrome: bicornuate uterus (European Society for Human Reproduction and Embryology/European Society for Gynaecological Endoscopy U3b C0 V0), a giant ASM (8.2 × 6 × 9.2 cm) in the presacral sac communicating with the subarachnoid space through a sacral bony defect, and a posterior meningocele (2.8 × 1.5 cm). Preanesthetic evaluation revealed moderate anemia (Hb 6.7 g/dL), an ASA (American Society of Anesthesiologists) I status following medical optimization, and several position-related and neurosurgical anesthetic risks. After multidisciplinary team planning involving anesthesiology, neurosurgery, and gynecology, the patient underwent a posterior trans-sacral approach for ligation of the meningocele under general anesthesia. The procedure—sacral laminectomy with ligation of the meningocele pedicle—was completed uneventfully; the patient remained neurologically intact, the lumbar drain was removed on postoperative day 5 with no cerebrospinal fluid (CSF) leak, and she was discharged in satisfactory, ambulatory condition with planned neurosurgical and gynecological follow-up. Multidisciplinary preoperative optimization—including hemoglobin correction, detailed imaging review, and structured anesthetic risk stratification—is critical for safe surgical management of Currarino syndrome with ASM. Awareness of CSF dynamics, positional hazards, and potential for intraoperative neurological injury is essential for the combined anesthesia–neurosurgery team.