Spectrum of intrapartum management strategies for giant fetal cervical teratoma

Shinjiro Hirose, Roman M. Sydorak, Kuojen Tsao, Charles B. Cauldwell, Kurt D. Newman, George B. Mychaliska, Craig T. Albanese, Hanmin Lee, Diana L Farmer, R. Ricketts

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Background/Purpose: The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management. Methods: A retrospective review of all patients referred since 1994 for prenatal management of a fetal neck mass was performed. Variables examined included gestational age at diagnosis and delivery, size and location of the neck mass, presence of fetal hydrops, associated anomalies, management methods, operating time, and outcome. Results: Seven patients were identified with a prenatal diagnosis of giant cervical teratoma. Four patients had fetal hydrops; of these, 2 died in utero of hydrops, and a third fetus underwent elective termination. The remaining hydropic and previable fetus underwent fetal surgery for resection of the mass. The 3 nonhydropic patients underwent ex utero intrapartum treatment (EXIT) procedures for airway control. Endotracheal intubation was possible in one patient, and one received a tracheostomy. In the third fetus, neither intubation nor tracheostomy were possible, and resection of the neck mass was performed on placental support. There were no deaths in the surgical group. Conclusions: The management of fetal giant cervical teratoma includes a spectrum of options. For the rare previable fetus with hydrops, fetal resection may be indicated. In patients with airway obstruction, EXIT procedure provides the luxury of time to obtain airway control either by intubation, tracheostomy, or, if necessary, tumor resection on placental support.

Original languageEnglish (US)
Pages (from-to)446-450
Number of pages5
JournalJournal of Pediatric Surgery
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2003

Fingerprint

Teratoma
Fetus
Hydrops Fetalis
Tracheostomy
Neck
Airway Management
Intubation
Edema
Intratracheal Intubation
Airway Obstruction
Prenatal Diagnosis
Gestational Age
Therapeutics
Neoplasms

Keywords

  • Airway management
  • Cervical teratoma
  • Ex utero intrapartum treatment procedure
  • Fetal surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Hirose, S., Sydorak, R. M., Tsao, K., Cauldwell, C. B., Newman, K. D., Mychaliska, G. B., ... Ricketts, R. (2003). Spectrum of intrapartum management strategies for giant fetal cervical teratoma. Journal of Pediatric Surgery, 38(3), 446-450. https://doi.org/10.1053/jpsu.2003.50077

Spectrum of intrapartum management strategies for giant fetal cervical teratoma. / Hirose, Shinjiro; Sydorak, Roman M.; Tsao, Kuojen; Cauldwell, Charles B.; Newman, Kurt D.; Mychaliska, George B.; Albanese, Craig T.; Lee, Hanmin; Farmer, Diana L; Ricketts, R.

In: Journal of Pediatric Surgery, Vol. 38, No. 3, 01.03.2003, p. 446-450.

Research output: Contribution to journalArticle

Hirose, S, Sydorak, RM, Tsao, K, Cauldwell, CB, Newman, KD, Mychaliska, GB, Albanese, CT, Lee, H, Farmer, DL & Ricketts, R 2003, 'Spectrum of intrapartum management strategies for giant fetal cervical teratoma', Journal of Pediatric Surgery, vol. 38, no. 3, pp. 446-450. https://doi.org/10.1053/jpsu.2003.50077
Hirose, Shinjiro ; Sydorak, Roman M. ; Tsao, Kuojen ; Cauldwell, Charles B. ; Newman, Kurt D. ; Mychaliska, George B. ; Albanese, Craig T. ; Lee, Hanmin ; Farmer, Diana L ; Ricketts, R. / Spectrum of intrapartum management strategies for giant fetal cervical teratoma. In: Journal of Pediatric Surgery. 2003 ; Vol. 38, No. 3. pp. 446-450.
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