Congenital Intracranial Teratoma: Management Challenges!

Congenital brain tumors are extremely rare. Among them teratomas are the most common. They make up one-third of all congenital brain tumors. Late diagnosis, poor prognosis, and majority being delivered by cesarean section (subjecting the mother to increased morbidity) add to the complexities and challenges of the case. We report a rare case of a massive congenital brain tumor diagnosed prenatally on ultrasound. Because of the poor prognosis and associated craniomegaly, pregnancy termination was contemplated at 28 weeks aiming at vaginal delivery, despite a high probability of an eventual cesarean delivery due to the associated macrocrania. Intrapartum second stage of labor was protracted due to nondescent of the large head; however, providentially there was timely skull rupture of the fetus facilitating a vaginal delivery. The cerebral tumor was confirmed at autopsy to be an immature teratoma. There were no other associated malformations. Ultrasound has emerged as major modality in prenatal diagnosis aiding the antenatal preparation of the prospective parents and the multidisciplinary team for the poor outcome. The knowledge gained and anticipated prognosis help immensely in planning the management, thereby avoiding subjecting the woman to cesarean section and its morbidity.