Contemporary management and surgical outcomes of sacrococcygeal teratoma

BackgroundSacrococcygeal teratoma (SCT) is a rare but significant neonatal tumor. Increasingly, SCTs are diagnosed prenatally, with fetal imaging playing a pivotal role in planning and management.MethodsWe conducted a retrospective review of five neonates with SCT treated at our institution between 2020 and 2025. Clinical presentation, imaging, surgical management, pathology, postoperative outcomes, and follow-up were analyzed.ResultsFour patients were diagnosed prenatally by ultrasound and underwent fetal MRI for detailed characterization of tumor anatomy and assessment of intrapelvic extension. MRI findings influenced risk stratification which guided delivery and surgical planning, complementing serial ultrasound monitoring for maternal-fetal well-being and tumor progression. One patient required in utero intervention for hydrops with polyhydramnios. Despite high-resolution imaging, one patient's tumor was intraoperatively reclassified to a higher Altman type, highlighting limitations of prenatal imaging in predicting exact tumor extent. All patients underwent coccygectomy, with surgical approaches tailored to tumor complexity; two required plastic surgery closure due to large or ruptured lesions. Pathology revealed mature or immature teratoma in four patients and a higher-grade immature teratoma in one patient. Complications were limited to wound dehiscence. At follow-up (8-36 months), there was no recurrence, and all patients demonstrated excellent cosmetic and functional outcomes.ConclusionsThis case series highlights the importance of prenatal diagnosis, individualized surgical planning, and multidisciplinary care in the management of neonatal SCT. Fetal MRI is a critical adjunct to prenatal ultrasound in the evaluation of SCT, offering superior anatomic detail, enhancing perinatal counseling, and guidance of surgical preparedness.