J Neurol Surg Rep 2016; 77(03): e118-e120
DOI: 10.1055/s-0036-1586211
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Management of Giant Cervical Teratoma with Intracranial Extension Diagnosed in Utero

Jayesh P. Thawani
1   Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Michael J. Randazzo
2   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Nickpreet Singh
2   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Jared M. Pisapia
1   Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Kalil G. Abdullah
1   Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Phillip B. Storm
1   Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
3   Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4   The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

05 May 2016

19 June 2016

Publication Date:
26 July 2016 (online)

Abstract

Cervical teratomas are rare germ cell tumors affecting the fetus that are associated with significant morbidity and mortality due to an increased risk of airway obstruction at delivery. These tumors can commonly produce polyhydramnios that results from the fetus' impaired ability to swallow amniotic fluid. Improved rates of prenatal diagnosis through comprehensive evaluations and imaging have dramatically impacted the perinatal management of infants with this condition. Here, we report a patient diagnosed with polyhydramnios whose fetus was discovered to have a giant cervical teratoma on imaging studies. The child underwent surgical resection after having the airway secured under the uteroplacental support as part of an ex utero intrapartum treatment procedure performed at 37 weeks. The following gross pathological and magnetic resonance images demonstrate this condition and its currently accepted treatment.

Funding

None.


 
  • References

  • 1 Laje P, Johnson MP, Howell LJ , et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediatr Surg 2012; 47 (6) 1208-1216
  • 2 Hubbard AM, Crombleholme TM, Adzick NS. Prenatal MRI evaluation of giant neck masses in preparation for the fetal exit procedure. Am J Perinatol 1998; 15 (4) 253-257
  • 3 Peiró JL, Sbragia L, Scorletti F, Lim FY, Shaaban A. Management of fetal teratomas. Pediatr Surg Int 2016;
  • 4 Sheikh F, Akinkuotu A, Olutoye OO , et al. Prenatally diagnosed neck masses: long-term outcomes and quality of life. J Pediatr Surg 2015; 50 (7) 1210-1213
  • 5 Liechty KW, Crombleholme TM, Flake AW , et al. Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure. Am J Obstet Gynecol 1997; 177 (4) 870-874
  • 6 Jackson EM, Schwartz DM, Sestokas AK , et al. Intraoperative neurophysiological monitoring in patients undergoing tethered cord surgery after fetal myelomeningocele repair. J Neurosurg Pediatr 2014; 13 (4) 355-361
  • 7 Walz PC, Schroeder Jr JW. Prenatal diagnosis of obstructive head and neck masses and perinatal airway management: the ex utero intrapartum treatment procedure. Otolaryngol Clin North Am 2015; 48 (1) 191-207
  • 8 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (6) 857-861
  • 9 Kelly MF, Berenholz L, Rizzo KA, Greco R, Wolfson P, Zwillenberg DA. Approach for oxygenation of the newborn with airway obstruction due to a cervical mass. Ann Otol Rhinol Laryngol 1990; 99 (3 Pt 1): 179-182
  • 10 Mychaliska GB, Bealer JF, Graf JL, Rosen MA, Adzick NS, Harrison MR. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg 1997; 32 (2) 227-230 , discussion 230–231
  • 11 Langer JC, Fitzgerald PG, Desa D , et al. Cervical cystic hygroma in the fetus: clinical spectrum and outcome. J Pediatr Surg 1990; 25 (1) 58-61 , discussion 61–62
  • 12 Azizkhan RG, Haase GM, Applebaum H , et al. Diagnosis, management, and outcome of cervicofacial teratomas in neonates: a Childrens Cancer Group study. J Pediatr Surg 1995; 30 (2) 312-316
  • 13 Taghavi K, Berkowitz RG, Fink AM, Farhadieh RD, Penington AJ. Perinatal airway management of neonatal cervical teratomas. Int J Pediatr Otorhinolaryngol 2012; 76 (7) 1057-1060