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
Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel.
Department of Otolaryngology Head and Neck Surgery, Rambam Health Campus, Haifa, Israel.
J Med Case Rep. 2019 Mar 10;13(1):73. 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.
巨大先天性颈部畸胎瘤通常血管高度丰富；因此，除了出生时危及生命的气道阻塞外，它还存在切除过程中大量致命性失血的高风险。在本病例中，对供应巨大先天性颈部畸胎瘤的颈动脉进行血管内栓塞是出生后不久进行的三阶段治疗的一部分，并促成了总体良好的结果。此前未描述过颈部畸胎瘤病例的栓塞治疗。
我们报告一例来自西班牙裔犹太裔的早产新生儿，患有巨大、血管高度丰富的先天性颈部畸胎瘤，该病例分三个阶段成功治疗：（1）经过广泛的术前规划后，通过产时宫外治疗程序分娩，随后进行气管造口术；（2）对供应肿瘤的颈动脉进行血管内栓塞，以减少切除过程中的失血；（3）完整的手术切除。从产前诊断出颈部肿块后不久开始，父母就参与了所有伦理和医疗决策。
从医学和伦理角度来看，巨大先天性颈部畸胎瘤的治疗通常具有挑战性。精心的围产期规划和父母的参与至关重要。肿瘤供血血管的血管内栓塞可显著改善切除结果和总体预后。
