Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004)

Makin, Erica; Hyett, Jon; Ade-Ajayi, Niyi; Patel, Shailesh; Nicolaides, Kypros H.; Davenport, Mark

doi:10.1016/j.jpedsurg.2005.11.017

Cited by 103 publications

(72 citation statements)

References 34 publications

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“…The other two survivors remain healthy. There is anecdotal experience of less invasive techniques, arresting flow in feeding vessels either by fetoscopic laser , interstitial thermocoagulation (Makin et al, 2006) as well as radiofrequency ablation (Lam et al, 2002). The latter can cause collateral tissue damage (Paek et al, 2001).…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%

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The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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Section: Sacrococcygeal Teratomamentioning

confidence: 99%

“…The latter can cause collateral tissue damage (Paek et al, 2001). Needle-guided intravascular embolisation with alcohol or histoacrylor coils has been reported, but without measurable success (Benachi et al, 2006;Makin et al, 2006;Perrotin et al, 2006).…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%

The making of fetal surgery

et al. 2010

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“…Yet, a subgroup of SCT are large, fast-growing, and highly vascularized tumors, which set the fetus at risk for anemia and cardiac failure due to arterial-venous fistulas. Fetal hydrops and placentomegaly are accepted indicators for fetal intervention [112][113][114][115]. Causative approaches comprise open fetal tumor resection or debulking, which was published in eight cases with a mean GA of 28 weeks (range [26][27][28][29] and four survivors [116][117][118].…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%

“…Causative approaches comprise open fetal tumor resection or debulking, which was published in eight cases with a mean GA of 28 weeks (range [26][27][28][29] and four survivors [116][117][118]. There is casuistic experience with less-invasive interventions such as thermocoagulation, radiofrequency ablation, embolization, and laser surgery [115,[119][120][121]. The London group treated four hydropic fetuses with laser; only one survived after preterm birth at 32 weeks, two died in utero, and one as a neonate after preterm delivery at 28 weeks [115].…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%

“…There is casuistic experience with less-invasive interventions such as thermocoagulation, radiofrequency ablation, embolization, and laser surgery [115,[119][120][121]. The London group treated four hydropic fetuses with laser; only one survived after preterm birth at 32 weeks, two died in utero, and one as a neonate after preterm delivery at 28 weeks [115]. In an earlier case report, Hecher et al [122] describe successful partial SCT ablation via fetoscopic laser at 20 weeks of gestation.…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%

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The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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We aimed to review the state of affairs in the field of embryo-fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twintwin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryofetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.

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Congenital hepatoblastoma: Expanding knowledge, improving outcomes

Gigola,

Morini,

Libro

et al. 2024

Pediatric Blood & Cancer

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Hepatoblastoma (HB) is a rare liver tumour, and its congenital counterpart (CHB) is even less frequent. CHB has a clinically challenging management and a generally perceived worse outcome. This study aims to review the literature on CHB to better define presentation, diagnosis, available treatments and management options. The analysis of outcomes suggests that a significant portion of mortality is unrelated to the malignant nature of the tumour. Key factors influencing overall outcomes were identified: mortality linked to the ‘mass effect’ during both the prenatal (22%) and perinatal (32%) stages, as well as ‘oncological’ mortality encompassing tumour and/or treatment‐related factors (46%). Overall, after birth, CHB does not seem to confer a worse oncological prognosis per se, and should be managed similarly to older children, if patients are stable enough to undergo proper staging and treatment. A deeper knowledge and better outcomes would come from a large, homogeneous, collection of data possibly allowing a global protocol, focusing on a comprehensive management of CHB.

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Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004)

Cited by 103 publications

References 34 publications

The making of fetal surgery

The making of fetal surgery

The use of endoscopy in fetal medicine

Congenital hepatoblastoma: Expanding knowledge, improving outcomes

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