Variable arterial supply in a giant sacrococcygeal teratoma: implications for surgical planning

Background Giant sacrococcygeal teratomas (SCT) are associated with a high risk of perioperative hemorrhage. In preterm neonates with limited circulatory reserve, even moderate blood loss may lead to hemodynamic instability. Ligation of the middle sacral artery prior to tumor mobilization or preoperative embolization have been described in selected cases to reduce intraoperative bleeding by occlusion of major tumor-feeding vessels. Case presentation We report a preterm neonate with a giant SCT born at 32 weeks of gestation. Angiography revealed a small middle sacral artery, while the dominant arterial supply originated from hypertrophic branches of both internal iliac arteries. Selective glue embolization of the main feeding vessels was performed 12 hours after birth via femoral and axillary access. Subsequent surgical resection with coccygectomy was completed with controlled blood loss. Conclusion This case highlights variability in the arterial supply of SCT and its implications for surgical planning. Preoperative angiography may assist in identifying dominant feeding vessels, while selective embolization can support hemorrhagic control in selected cases.