Objective: Lumbo-peritoneal shunt was used as an alternative treatment in a large anterior sacral meningocele, a rare congenital malformation, is illustrated. Clinical Presentation: A 48-year-old female patient presented with a two-month history of progressive paraparesis, leg pain and numbness of both legs. The investigation demonstrated spina bifida with a huge sac of meningocele, protruding anteriorly into the pelvic cavity. On two previous surgical operations for closure, the fistula through the posterior transsacral approach failed 20 years ago at another hospital, but her symptoms had subsided spontaneously without explanation. She came to Thammmasat Hospital with an episode of spinal cord compression for 2 months. Management: Because of the old surgical scar and high pressure of the meningocele, a lumbo-peritoneal shunt was selected to drain the cerebrospinal fluid from the meningocele to the peritoneal cavity. Conclusion: Lumbo-peritoneal shunting is an optional treatment for a large sacral meningocele, especially in a large fistula with unsuccessful surgical closure.