Two-Staged Resection of an Infantile Spinal Epidural Teratoma With Intrathoracic Extension: Surgical Case Report With Literature Review.

BACKGROUND AND OBJECTIVES: Spinal 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. METHODS: A 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. RESULTS: Histopathology 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. CONCLUSION: GTR 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.