ReviewNeurosurgery practice2026
Two-Staged Resection of an Infantile Spinal Epidural Teratoma With Intrathoracic Extension: Surgical Case Report With Literature Review.
Review in Neurosurgery practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesSpinal epidural teratoma (SET) is a rare spinal tumor, particularly in the pediatric population. Because of its rarity and potential for extensive growth into both intraspinal and extraspinal compartments, surgical strategies are not well-standardized. This study aims to describe a successful 2-stage surgical approach for an extensive infantile SET and review the existing literature.
methodsA 1-month-old male infant presented with a large SET extending from T4 to L2 and into the posterior mediastinum. A two-stage surgical approach was performed to achieve gross total resection (GTR). The intraspinal tumor was removed using a split-spinous process laminotomy from T7 to L3. This technique used the natural flexibility of the infant's vertebral arches to create an "open-door" access without detaching the paravertebral muscles. The second surgery was performed 1 month later for the remnant tumor located inside the posterior mediastinal space. The intrathoracic tumor was removed using a thoracoscope with only three 5-mm ports and a small incision for specimen extraction.
resultsHistopathology confirmed a mature teratoma. Postoperative MRI demonstrated GTR. The patient remained neurologically intact and was discharged without respiratory or surgical complications. At the 16-month follow-up, there was no evidence of recurrence or spinal deformity. A literature review identified only 10 previous cases of pediatric SET, highlighting a male predominance and a high frequency of multilevel extension. Paraparesis was common in most cases, whereas 2 infants presented with dyspnea because of mediastinal compression. Histologically, all except 1 case were mature teratomas, and all cases treated with GTR remained recurrence-free.
conclusionGTR is the gold standard for pediatric SET because of its histologically mature nature. A staged approach with "open-door" split-spinous process laminotomy and thoracoscopic surgery was an effective strategy. Reducing surgical stress is essential in fragile infants with extensive SETs.
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