Prenatally diagnosed sacrococcygeal teratoma: a prognostic classification

Benachi, Alexandra; Durin, Luc; Maurer, Sabine Vasseur; Aubry, M. C.; Parat, Sophie; Herlicoviez, M.; Nihoul‐Feketé, Claire; Dumez, Yves; Dommergues, Marc

doi:10.1016/j.jpedsurg.2006.05.009

Cited by 82 publications

(76 citation statements)

References 14 publications

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“…These fetuses had a mortality rate of 52%. Four of six fetal deaths were also associated with hydropic signs (Benachi et al, 2006). Symptomatic interventions such as amniodrainage (polyhydramnios), intra-uterine transfusion (anaemia) and bladder shunting (urinary obstruction) have been reported as well.…”

Section: Sacrococcygeal Teratomamentioning

confidence: 95%

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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: 95%

“…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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“…In small babies, this may be associated with hyper-dynamic circulation, besides the risk of bleeding complications. [7] Controlling the median sacral artery prior to surgical excision has been recommended in some reports, which can be performed via laparoscopy. [21] The other poor prognostic aspect with solid tumors is related to the risk of malignancy.…”

Section: Both Were Malignantmentioning

confidence: 99%

“…Despite its wide spread acceptance, the Altman classification has been criticized for being descriptive rather than a practical classification, with limited impact on the prognosis [7]. Usui et al have shown early delivery and 'predominantly' solid tumors to be associated with higher risk of mortality [8].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Grading of Sacrococcygeal Teratoma: A Roadmap to Successful Resection

AbouZeid¹,

Mohammad²,

Elsherbeny³

et al. 2017

J Neonat Surg

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACTPurpose: to include the most relevant preoperative imaging features of sacrococcygeal teratoma (SCT) in a grading system that would provide guidance to surgeons during excision of such rare tumors.Patients and Methods: The medical records of patients with SCT, who were managed at our hospital during the period 2009 through 2016, were retrospectively reviewed. Only cases of SCT with available preoperative cross-sectional imaging studies (MRI and/or CT scans) were included in the study. The preoperative imaging features were correlated to the operative and pathological findings.Results: The study included 24 cases of SCT (20 females and 4 males). Their age at presentation ranged from day one to 36 months. The following were identified as relevant preoperative imaging features to be included in our proposed grading system: tumor size, level of deep extension of the tumor, and tumor consistency. Among predominantly cystic SCT, a special subtype C3 could be identified with its characteristic irregular internal cyst wall thickening caused by the in-growth of solid tumor component. These cases were always associated with immature pathology.Conclusion: MRI is a useful modality in the preoperative assessment of cases of SCT by providing a grading system that can indicate for the prognosis and degree of expected surgical challenge.

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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%

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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Prenatally diagnosed sacrococcygeal teratoma: a prognostic classification

Cited by 82 publications

References 14 publications

The making of fetal surgery

The making of fetal surgery

Preoperative Grading of Sacrococcygeal Teratoma: A Roadmap to Successful Resection

The use of endoscopy in fetal medicine

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