The Children's Hospital of Philadelphia
What Families and Physicians Should Know About Teratomas — Surgery: Mediastinium Teratoma
Alan W. Flake, MD: Mediastinal teratomas have different treatments depending on how they manifest, either before or at the time of delivery.
N. Scott Adzick, MD: Small- to medium-sized teratomas diagnosed before birth can simply be followed and addressed after birth. For those very large teratomas that cause compression of the developing heart and compression of the developing lungs, they can lead in turn to hydrops usually based on the location and compression of the chest mass, which may require fetal intervention.
Alan W. Flake, MD: We've had to resect mediastinal teratomas in fetuses that have developed hydrops that we felt would not survive without fetal intervention.
N. Scott Adzick, MD: We have had cases of mediastinal teratomas that became mischief-makers late in gestation, and those have been managed via the ex utero intrapartum therapy approach.
Alan W. Flake, MD: In that circumstance, you actually have to decompress the chest in order to put a tube in the airway, and we do that by opening the fetal chest, removing the tumor, and then establishing the airway and then dividing the umbilical cord and delivering the fetus.