**4.2 Surgical management**

Most fetal teratomas could be managed by planned delivery and postnatal surgery. The earlier the diagnosis and surgical intervention, the better the prognosis. A complete surgical excision of the tumor including coccygectomy is necessary, in order to avoid recurrence. A long term observation and follow-up is required for any urinary or bowel dysfunction.

Mature teratomas should not recur, if complete surgical excision and coccygectomy were achieved properly. Recurrence is reported in literature, as 2–35%, in patients with immature teratomas operated after the age of 5 months and is related to tumor spillage or incomplete excision.

At the time of birth, most lesions are benign and surgical resection can be accomplished with relatively low morbidity and mortality. The incidence of

**63**

**Figure 5.**

*ulceration of the skin.*

*Prenatal Diagnosis and Management of Sacrococcygeal Teratomas*

may be used to detect early occurrence of malignancy.

The goals of surgical resection of an SCT are:

• Reconstruction of the pelvic floor and ano-rectal sphincter

sacral artery or branches from the hypogastric arteries [4, 7, 12].

*Large SCT in a newborn—preoperative. SCT represents more than 50% of birthweight, with visible* 

After inserting a urinary catheter, the patient is placed in the prone jack-knife position. A V-shaped incision is made at the superior margin of the tumor. It is important to identify the course of the anus by placing a tube in the anal canal. After raising skin flaps, the muscles are dissected from the tumor which must be resected with the coccyx, after ligation of its main blood supply, which are middle

malignancy in SCT is increasing with age. Failure to remove the coccyx results in 30–40% recurrence rate, with a higher probability of malignancy. Alpha fetoprotein

Management of SCT depends on fetal lung maturation and presence of placental enlargement and/or fetal hydrops. When maturity of fetal lung without placental enlargement and/or hydrops fetalis, planned cesarean section is indicated. Some authors recommend preventive early delivery by cesarean section when the tumor exceeds the diameter of 5 cm, to avoid complications such as rupture and hemorrhage. The primary treatment of SCT is early surgical resection with complete excision of the coccyx. Early surgical intervention is associated with better prognosis. The surgical approach depends on the degree of pelvic extension. Posterior sacral approach is recommended in type I and II, and combined abdominal and posterior sacral approaches in type III and IV. The technique of wide resection of benign lesions with coccygectomy is helpful in preventing recurrence and has changed

*DOI: http://dx.doi.org/10.5772/intechopen.87987*

little over the last four decades.

• Removal of the coccyx

• Complete resection of the tumor

• Acceptable cosmetic appearance

**Figure 4.** *Antenatal diagnosis of SCT using MRI and measurements.*
