Intracranial teratomas in children: the role and timing of surgical removal

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.</jats:p></jats:sec>

A Case of Mature Cystic Teratoma Arising from the Fourth Ventricle

“…The largest series of intracranial pediatric teratomas reported by Noudel et al revealed pure mature teratomas in 5 out of 14 patients. However, all of them were located in the sellar or the pineal regions and none of them in the posterior fossa [9]. …”

Malignant transformation and treatment of cystic mixed germ cell tumor

“…Different locations have different symptoms. The tumor may appear cystic, heterogeneous, and full of solids in MRI [4][5][6][7][8] . Intracranial germ cell tumors can also be divided into germinomatous and nongerminomatous germ cell tumors.…”

“…Common sites of intracranial germ cell tumors include the pineal region and sellar area, basal ganglia area, cavernous sinus area, posterior fossa, and brainstem [5][6][7][8] . Different locations have different symptoms.…”

Critical review of the management of primary central nervous nongerminomatous germ cell tumors

“…Meanwhile, embryonal carcinoma may have low levels or absence of these markers . Furthermore, limited tissue biopsies may not provide a complete picture of all NGGCT elements composing the tumor . Accordingly, the Japanese practice has been to undertake extensive surgical removal and histopathological verification in order to accurately diagnose CNS‐GCT.…”