Posterior sagittal approach for resection of sacrococcygeal teratomas

Jan, Iftikhar Ahmad; Khan, Ejaz Ahmed; Yasmeen, Nuzhat; Orakzai, Hazratullah; Saeed, Jahria

doi:10.1007/s00383-011-2870-z

Cited by 13 publications

(11 citation statements)

References 6 publications

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“…The posterior-sagittal incision and approach causes less disfigurement, preserves the normal-looking median-raphe and is more cosmetic as compared to the Inverted V-shaped or Chevron incision in the posterior-sacral approach. [2] However, this is suitable for smaller tumors (<5 cm) which are predominantly extrapelvic or have a shallow pelvic extension, not adherent to any vascular structure and located centrally. The muscles of the pelvic floor are better appreciated making the surgery and repair more convenient.…”

Section: Discussionmentioning

confidence: 99%

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Sacrococcygeal teratoma: Clinical characteristics, management, and long-term outcomes in a prospective study from a Tertiary Care Center

Yadav

Acharya

Bagga

et al. 2020

J Indian Assoc Pediatr Surg

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Introduction:The study focuses on the clinical presentation, management, and outcomes (both short term and long term) in patients with sacrococcygeal teratoma managed over a decade in a tertiary care center.Materials and Methods:This is a prospective study on children with sacrococcygeal teratoma over 12 years data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, physical extent of mass (including Altman classification), levels of alpha-fetoprotein, surgical approach, histopathology, clinical outcome, recurrence and long-term results including bladder-bowel dysfunction and neurological impairment. Functional results were evaluated clinically and radiologically.Results:During the study, 41 patients (male to female ratio of 1:3.1) with a median age of 36 days (1 day–11.6 years) with sacrococcygeal teratoma were managed at our center. The mean follow-up duration was 54 months (range 19–110 months). Nearly, two-thirds of the tumors were either Altman Type 1 or 2. Yolk sac tumor was present in 8 (19.5%) patients, while the rest has either mature or immature teratoma. Tumors were removed through a posterior sagittal or a chevron incision. In seven patients, abdominosacral approach was necessary. Eight patients with malignant disease received chemotherapy (neoadjuvant in 5). Overall survival was 95% at a mean follow-up of 54 months. Among the late complications, three patients had a local recurrence of tumor, and urinary dribbling was present in three patients.Conclusions:Teratomas are the most common germ cell tumors of the sacrococcygeal region. Most of the tumors are benign, and the incidence of malignancy increases with age. The evaluation of malignancy is, therefore, necessary in these children. Excellent survival of 95% was achieved in this series. Morbidity due to associated malformation, disease recurrence, and treatment may persist in these patients; hence, proper follow-up is needed.

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Section: Discussionmentioning

confidence: 99%

“…Abdominosacral approach was reserved for lesions which could be palpated per abdomen. Sacral route with posterior sagittal incision[2] was preferred for tumors with size <5 cm and located more in the midline. Sacral route with inverted V-shaped or Chevron incision was used for larger or eccentrically located masses.…”

Section: Methodsmentioning

confidence: 99%

Sacrococcygeal teratoma: Clinical characteristics, management, and long-term outcomes in a prospective study from a Tertiary Care Center

Yadav

Acharya

Bagga

et al. 2020

J Indian Assoc Pediatr Surg

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“…The restoration of a perineum and a gluteal region of normal appearance. Different types of approaches are used, including abdominal and sacral [32][33][34][35]. Other surgical techniques have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Other surgical techniques have been proposed. Jan et al proposed a sagittal incision to limit tissue damage, due to the sagittal orientation of muscles in this region, and to achieve better esthetic results [35]. Laparoscopy offers an excellent vision of this narrow pelvic space, thus preserving the sphincter and nerve structures, guaranteeing a good functional result later.…”

Section: Discussionmentioning

confidence: 99%

Sacro-coccygeal Teratoma in a Child of 6 Months: A Case Report

Frederic¹,

Paul²,

Essola³

et al. 2019

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Sacro-coccygeal teratoma (SCT) is a type of tumor which mostly occurs in newborn babies. The vast majority of this type of tumor is benign. That pathology can be diagnosed antenatally or at birth. Teratomas, especially those diagnosed in the neonatal period, occur most frequently in the sacrococcygeal region. Clinically in many cases, we can observe a large swelling (mass) in the sacrococcygeal region. In some cases, there are signs of compression following by the displacement of the rectum and pelvic organs. Alphafetoprotein is the main biological test used. In association morphologically by echography, CT-scan, MRI and others, the tumor is classified. The classification used is the topographical one of TSCs, which was proposed by Altman to the American Academy of Pediatric Surgery. The mainstay of therapy is the complete surgical removal. We present a case of a newborn (6 months), female, with teratoma sacro-coccygeal. At birth the baby was noticed to have large swelling (mass), without any sign of compression of others organs. Clinical and paraclinical signs permitted us to conclude of a SCT type II of Altman's classification. A surgery was performed with a sacral approach. Histologically, tumors were classified into good (mature) category.

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“…Operative procedure: The sacral (perineal) approach was used to excise the sacrococcygeal masses either via the classic 'chevron' incision [4], or the vertical posterior sagittal approach [12]. In one case, a combined abdomino-perineal approach was needed to excise a tumor with deep intra-abdominal extension.…”

Section: Methodsmentioning

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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Posterior sagittal approach for resection of sacrococcygeal teratomas

Cited by 13 publications

References 6 publications

Sacrococcygeal teratoma: Clinical characteristics, management, and long-term outcomes in a prospective study from a Tertiary Care Center

Sacrococcygeal teratoma: Clinical characteristics, management, and long-term outcomes in a prospective study from a Tertiary Care Center

Sacro-coccygeal Teratoma in a Child of 6 Months: A Case Report

Preoperative Grading of Sacrococcygeal Teratoma: A Roadmap to Successful Resection

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