Acting on macrocephaly in the neonatal period: an illustrative case of congenital teratoma

An 11-week-old baby was brought to the paediatric emergency department by his mother with a 2-day history of inconsolable crying. On examination, clinical features of macrocephaly, separated sutures and ‘sunsetting’ of the eyes were noted. Abnormal head circumference measurements had been obtained on several occasions since birth, but were not acted on contrary to local guidance. During the emergency admission, an urgent CT scan revealed a large posterior fossa tumour consistent with a teratoma causing severe obstructive hydrocephalus. Following referral to a neurosurgical centre, emergency ventricular drainage and debulking surgery were performed, unfortunately with no option for cure. Distress to mother and baby could have been reduced with a more timely diagnosis.