Congenital intracranial
immature teratomas carry a dismal prognosis, and the usefulness of
chemotherapy for these
tumors has not been elucidated. The authors report on the successful management of a case of congenital intracranial
immature teratoma by using
neoadjuvant chemotherapy and surgery after the failure of an initial attempt at resection. The patient was an infant who had begun
vomiting frequently at the age of 12 days and had been admitted to a hospital at the age of 18 days with continued
vomiting, increased head circumference, and disturbance of consciousness. A CT scan of the brain revealed a large mass in his posterior fossa and
hydrocephalus. Surgery was performed on an emergent basis, but only minor
tumor resection could be performed due to massive intraoperative
hemorrhage. The histopathological diagnosis was
immature teratoma. Postoperatively, the infant was in critical condition due to severe postoperative complications, and when he was transferred to the authors' institution 43 days after birth, his respiratory condition was still unstable because of lower
cranial nerve palsy.
Chemotherapy with
carboplatin and
etoposide resulted in moderate shrinkage of the
tumor. Further
chemotherapy led to improvement in the patient's general condition and
weight gain, which allowed for a second attempt at resection. During this second surgery, which was performed when the child was 8 months of age, after 8 courses of
chemotherapy, the
tumor was completely resected with little
bleeding. Histological findings from the second operation were consistent with mature
teratoma. This case indicates that upfront
chemotherapy may be effective for the initial management of such cases. Although the objective response to the treatment was modest,
chemotherapy reduced the hemorrhagic nature of the
tumor, facilitated improvement of the patient's general condition, and allowed for successful resection.