Intracranial teratomas in children: the role and timing of surgical removal

In this study, the authors report their experience with the surgical treatment of intracranial teratomas with
an emphasis on the indications for delayed resection after oncological treatment.
Methods. The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean
age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis
revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant
germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2
subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment
because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in
3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature
teratoma after oncological treatment.
Results. Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are
currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients
(33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing
of surgery.
Conclusions. The results of this study support the belief that microsurgical removal is the only effective treatment
for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive
teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant