Radiofrequency ablation of human fetal sacrococcygeal teratoma.
OBJECTIVE
Fetuses with solid, highly vascularized sacrococcygeal teratomas can die as a result of the vascular steal syndrome. This is the first report in which a percutaneous technique, radiofrequency ablation, was used to interrupt blood flow to a sacrococcygeal teratoma in 4 human fetuses.


METHODS
A radiofrequency ablation probe was percutaneously inserted into the fetal tumor under ultrasonographic guidance. In 2 fetuses a significant portion of the tumor mass was ablated, whereas in the other 2 fetuses only the major feeding vessels were targeted.


RESULTS
Two infants were delivered at 28 and 31 weeks' gestation, respectively, and are doing well. In 2 other cases hemorrhage into the tumor led to an unfavorable fetal outcome.


CONCLUSIONS
Ablation of a majority of the tumor tissue in sacrococcygeal teratoma is not necessary and proved fatal in two instances. Targeted ablation of the feeding tumor vessels diminishes blood flow sufficiently to reverse high-output fetal heart failure.
Fetal Treatment Center, Department of Surgery, University of California, San Francisco 94143-0570, USA.
B W
BW
Paek
R W
RW
Jennings
M R
MR
Harrison
R A
RA
Filly
T A
TA
Tacy
D L
DL
Farmer
C T
CT
Albanese
D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D005315:Fetal Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D011247:Pregnancy; D012445:Sacrococcygeal Region / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D013724:Teratoma / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D015149:Tocolytic Agents / Q000627:therapeutic use; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal
D015149:Tocolytic Agents; D007213:Indomethacin