Vaginal Delivery Using Cranioclasia following Prenatal Diagnosis of a Giant Fetal Intracranial Teratoma

Abstract

Intracranial teratoma, although a rare disease, is nonetheless the most common of the congenital tumors of the central nervous system in the neonatal period. It can be diagnosed antenatally by ultrasound. The prognosis for fetal forms of teratoma is very grim. We report here the case of an immature teratoma identified at 26 weeks’ gestation and discuss its obstetric consequences, in particular, the technical procedures for a medically-indicated termination of pregnancy in view of the massive increase in head circumference associated with this tumor.

Fetal intracranial immature teratoma: presentation of a case and a systematic review of the literature

“…A low flow will be observed in the periphery (4,6). The NMR scan helps us to locate and degree of invasion, showing a heterogeneous tumor with hyper-echogenic and hypo-echogenic images, in T1 as well as in T2 (5,16).…”

“…Thus, a normal ultrasound at the beginning of gestation does not rule out the possibility of it presenting later (9). A high suspicion is going to be established with the presence of an echogenic mass in the ultrasound in the 2nd or 3rd trimester that leads to an increase in the biparietal diameter and / or a head circumference accompanied by frecuent of calcifications, cystic foci, changes in the normal brain structure, or other ultrasound signs (2,8,10 (4,13). They are the most frequent histological type, representing between 26 to 50% of fetal brain tumors (9).…”

“…However, extracranial growth to the orbits is possible, as well as to the nose, oropharynx, neck, etc… Being the worse prognosis (4,15).…”

“…Prior to establishing the definitive diagnosis, we should rule out possible hemorrhage, vascular malformation, or a rare entity, but we must not forget the so-called 'fetus in J U S T A C C E P T E D fetus', and that it consists of the presence of a mass with fetal characteristics within a normal fetus, and being able to show cardiac activity in its interior (4,10,15).…”

“…They are usually suspected in the ultrasound of the 2nd or 3rd trimester, due to the appearance of a well-defined intracranial mass often associated with hydrocephalus, polyhydramnios, hydrops fetal, and even fetal death (3). They have a high growth potential, with tumor sizes greater than 5 cm being observed at the time of their presentation (2,4). The definitive diagnosis, however, is established in the histological study of the tumor piece (5,6).…”