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 language | English (US) |
|---|---|
| Pages (from-to) | 446-450 |
| Number of pages | 5 |
| Journal | Journal of Pediatric Surgery |
| Volume | 38 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2003 |
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Keywords
- Airway management
- Cervical teratoma
- Ex utero intrapartum treatment procedure
- Fetal surgery
ASJC Scopus subject areas
- Surgery
Cite this
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 journal › Article
}
TY - JOUR
T1 - Spectrum of intrapartum management strategies for giant fetal cervical teratoma
AU - Hirose, Shinjiro
AU - Sydorak, Roman M.
AU - Tsao, Kuojen
AU - Cauldwell, Charles B.
AU - Newman, Kurt D.
AU - Mychaliska, George B.
AU - Albanese, Craig T.
AU - Lee, Hanmin
AU - Farmer, Diana L.
AU - Ricketts, R.
PY - 2003/3/1
Y1 - 2003/3/1
N2 - 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.
AB - 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.
KW - Airway management
KW - Cervical teratoma
KW - Ex utero intrapartum treatment procedure
KW - Fetal surgery
UR - http://www.scopus.com/inward/record.url?scp=0037370230&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037370230&partnerID=8YFLogxK
U2 - 10.1053/jpsu.2003.50077
DO - 10.1053/jpsu.2003.50077
M3 - Article
C2 - 12632365
AN - SCOPUS:0037370230
VL - 38
SP - 446
EP - 450
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 3
ER -