Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma

Role of pre-operative endovascular embolization of a giant sacrococcygeal teratoma in neonate: a case report

BACKGROUND

Giant sacrococcygeal teratomas (SCTs) are at risk of perinatal morbidity and mortality due to their high vascularity. Pre-operative embolization of the feeding arteries, prior to complete surgical resection, may assist in minimizing the intraoperative blood loss by occluding these feeding arteries.

CASE PRESENTATION

We present a case of a highly vascular giant SCT in a neonate, which was successfully embolized through an endovascular approach prior to surgery. The femoral artery approach was chosen, with access established using a Micropuncture introducer as a sheath. Embolization was performed using a combination of microcoils, Gelfoam slurry, and polyvinyl alcohol particles. The patient developed femoral artery spasm post-procedure, which resolved with the application of a glyceryl trinitrate patch.

CONCLUSIONS

Performing pre-operative endovascular embolization on a giant sacrococcygeal teratoma presents particular challenges, primarily due to the difficulty in assessing small vessels and the potential complications associated with this procedure. Nevertheless, this technique proves exceptionally valuable in helping the surgeon minimize blood loss during surgery, thereby reducing the risks of morbidity and mortality. Comprehensive planning for the embolization procedure is essential, encompassing the identification of potential vascular access points and alternatives, along with careful selection of the appropriate catheter.

Perinatal Outcomes of Intrauterine Interventions for Fetal Sacrococcygeal Teratoma Based on Different Surgical Techniques-A Systematic Review

Background: This study aims to evaluate the outcomes of fetal sacrococcygeal teratoma (SCT) submitted to prenatal interventions. Methods: We performed a systematic literature review of fetal SCT patients and compared the outcomes between open fetal surgery and percutaneous intervention. In addition, we also compared the results of SCT fetuses who did not undergo any surgical intervention (NI). Results: We identified 16 cases of open fetal surgery (OS), 48 cases of percutaneous fetal intervention (PI), and 93 NI patients. The survival rate was 56.2% in OS, 45.8% in PI (p = 0.568), and 71.0% in NI patients. The gestational age at delivery was earlier in cases where there was no survival compared to cases where the fetuses did survive across all evaluated cohorts (OS: p = 0.033, PI: p < 0.001, NI: p < 0.001). The gestational weeks at delivery in OS and PI fetuses were more similar; however, OS tended to be performed later on in pregnancy, and the affected fetuses had more severe presented findings. In our evaluation, we determined that the presence of fetal hydrops and cardiac failure had no significant impact on survival in SCT cases. In NI patients, polyhydramnios was much higher in fetuses who did not survive compared to their surviving cohorts (p < 0.001). Conclusions: In conclusion, gestational age at delivery can affect the short-term prognosis of fetuses affected with sacrococcygeal teratomas. Regardless of the mode of delivery or the necessity for intervention during the fetal period, monitoring for complications, including polyhydramnios, can prevent premature delivery.

Endovascular approaches in pediatric interventional oncology

The demand for interventional oncological (IO) treatment of pediatric cancers is becoming increasingly common, at least at several tertiary care institutions. The data and techniques used in pediatric IO are largely extrapolated from experience in adult patients. The management of pediatric tumors differs from that in adults in several categories, such as, the curative intent of treatment, wide use of general anesthesia, aggressive pain management, potentially longer hospital stay, variation in chemotherapy dosing etc. Additionally, pediatric cancers are managed by protocols directed by national and international oncology groups such as the Children’s Oncology Group (COG). Consequently, the translation and adoption of these techniques is gradual, but there is a noticeable uptrend due to the growing need. This review will update the current endovascular IO treatments for common pediatric liver, renal, bone and soft tissue tumors.

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas

Objective

The present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment.

Methods

The clinical data of 15 pregnant females with fetal SCT, admitted to Fujian  Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes.

Results

The 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5−10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia.

Conclusion

Fetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.

Coil occlusion of a congenital left ventricular aneurysm in a newborn

We report interventional treatment of a congenital left ventricular aneurysm in a neonate. The aneurysm was detected prenatally at 20 weeks of gestation. Postnatally, the aneurysm increased in size during the first few days of life and therefore we opted for interventional closure to abolish the potential risk of rupture. The aneurysm was entered with a 2.7 French microcatheter, and complete occlusion was achieved by successive placement of three detachable large volume coils (Ruby Coil Penumbra^R , Alameda, California). To the best of our knowledge, this is the first report describing interventional occlusion of a congenital ventricular aneurysm in early infancy. Interventional occlusion with detachable large volume coils appears to be an attractive alternative to surgical resection in patients presenting with ventricular outpouchings and narrow base connection to the ventricle.