Multidisciplinary Management of an Anterior Skull Base Teratoma in a Neonate

Teratomas are embryonal neoplasms composed of 2 or 3 germ layers. We present the case of a female neonate who had a rare, mature, skull base teratoma that was managed surgically by fetal surgery, neurosurgery, otolaryngology, and plastic surgery. Imaging revealed an anterior skull base teratoma with extension into the nasopharynx, resulting in gross enlargement of the right nostril and sinonasal cavity. An ex utero intrapartum treatment procedure was performed to establish an airway before placental support was removed. Subsequently, neurosurgery and ENT performed endonasal resection of the teratoma without intracranial involvement or cerebral spinal fluid leakage. Although originally not part of the surgical plan, plastic surgery was consulted and performed an advancement flap to repair the defect caused by the adhesion as well as reduce the substantially sized ala. After the resection, a 2-stage reconstruction was performed by the plastic and reconstructive surgeon. The first stage involved medial movement of the right ala and advancement lateral tissue to repair the nasal cleft. The second stage involved harvesting cartilage from the concha to reinforce the alar rim and further reducing nostril size by a Y-V advancement flap. The child is now 3 years of age and is without evidence of recurrence or neurological defects. She has an optimal, symmetrical cosmetic outcome of the nasolabial area. This rare case highlights the need for early diagnosis of these airway-obstructing masses to prepare for a safe delivery. Furthermore, a plastic surgery consult during the resection is indispensable to improved cosmetic outcomes.