Three-step management of a newborn with a giant, highly vascularized, cervical teratoma: a case report

• Published in: Journal of medical case reports 2019-03, Vol.13 (1), p.73-5, Article 73
• Main Authors: Hochwald, Ori, Gil, Ziv, Gordin, Arie, Winer, Zeev, Avrahami, Ron, Abargel, Eitan, Khoury, Asaad, Lehavi, Amit, Abecassis, Philippe, Eldor, Liron, Ben-Izhak, Ofer, Borenstein-Levin, Liron, Stienberg, Ran, Kugelman, Amir
• Format: Article
• Language: English
• Subjects: Airway management; Care and treatment; Carotid arteries; Case Report; Case reports; Cervical; Cervical cancer; Childbirth & labor; Congenital; Diagnosis; Endovascular embolization; Ethics; Ex utero intrapartum treatment; Genetic disorders; Health aspects; Hospitals; Newborn; Newborn infants; NMR; Nuclear magnetic resonance; Ostomy; Otolaryngology; Parents & parenting; Pediatrics; Succinylcholine; Surgery; Teratoma; Tracheostomy; Tumors; Veins & arteries
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-019-1976-0

A giant congenital cervical teratoma is often highly vascularized; thus, in addition to a life-threatening airway occlusion at birth it comprises a high risk for significant and lethal blood loss during resection. In the case presented, an endovascular embolization of the carotid artery that supplied a giant congenital cervical teratoma was done as part of a three-stage treatment soon after birth and contributed to an overall good outcome. Embolization in cases of cervical teratomas was not described previously. We present a case of a preterm newborn from a Sephardic jewish origin with a giant, highly vascularized, congenital cervical teratoma that was managed successfully in three stages: (1) delivery by an ex utero intrapartum treatment procedure after extensive preoperative planning and followed by tracheostomy, (2) endovascular embolization of the carotid artery that supplied the tumor in order to decrease blood loss during resection, and (3) complete surgical resection. The parents were involved in all the ethical and medical decisions, starting just after the cervical mass was diagnosed prenatally. The management of giant congenital cervical teratoma is often challenging from both a medical and ethical prospective. Meticulous perinatal planning and parents' involvement is crucial. Endovascular embolization of the tumor feeding vessels can significantly improve the resection outcome and overall prognosis.