Radiofrequency ablation of fetal cervical teratoma

Abstract

Background: Highly vascular fetal tumors can lead to death before viability as a result of vascular steal syndrome. Open fetal surgery is associated with significant risks for prematurity and maternal morbidity. Various local ablative techniques have been tried to reduce tumor vascularity, with variable success. Radiofrequency ablation has been performed for sacrococcygeal teratoma, but cervical teratoma poise further significant challenges with its proximity to vital neck structures.Purpose: This is the first report in which percutaneous radiofrequency ablation was used to reduce tumor vascularity in a human fetus with a large cervical teratoma.Methods: A partly solid, partly cystic neck tumor was first detected in a 19‐week fetus. The tumor grew rapidly and caused signs of cardiac decompensation by 26 weeks. After extensive counseling and ethics discussion, operation was performed at 28 weeks under general anesthesia. Radiofrequency ablation to the solid component of the tumor was performed with a nine‐prong retractable needle electrode with thermal couples (RITA), deployed to a maximum diameter of 5 cm. The operation was uneventful and fetal condition was monitored throughout the procedure.Results: Tumor growth was arrested temporarily with improvement of the cardiac status. Re‐growth of the tumor was noted after 32 weeks, necessitating delivery at 33 weeks. Postnatal investigation showed extensive tumor infiltration into the neck tissues and probable liver metastases. Biopsy showed immature teratoma, and chemotherapy was considered to be futile. Intensive care was withdrawn and the baby died 6 days after delivery.Conclusions: Radiofrequency ablation of fetal tumor in utero can reduce blood flow sufficiently to reverse high‐output fetal heart failure. Cervical tumors poise extra challenges with its proximity to vital neck structures. With careful and meticulous placement of the probe, ablation can be performed without injury to surrounding tissues. Experience in this area is preliminary and all such experiences should be reported.