Craniopagus parasiticus – a parasitic head protruding from temporal area of cranium: a case report

Abstract

BackgroundCraniopagus parasiticus is rare with an incidence of approximately four to six cases in 10,000,000 births. In our case, the head of the parasitic twin protruded from the temporal area of the normal twin’s cranium. The parasitic twin had two deformed lower limbs, of which one was rudimentary, and long bones of the bilateral lower limbs and some pelvic bone. Dissection of the mass of the parasitic twin’s body revealed the intestine but no chest organs or abdominal organs. There was a rudimentary labium but no vaginal opening. In resource-limited countries, maternal age or nutritional factors may play a role in craniopagus parasiticus.Case presentationA 38-year-old multigravida (gravida V para IV) woman of Amhara ethnicity was referred from a rural health center to our hospital due to prolonged second stage of labor at 42+1 weeks. On her arrival at our hospital, an obstetrician decided to do a caesarean section because she was unable to deliver vaginally. A live baby girl weighing 4200 g was delivered. The placenta was single and normal. Her Appearance, Pulse, Grimace, Activity, and Respiration scores were 7 and 9 at 1 and 5 minutes, respectively. She appeared to be grossly normal except for the parasitic co-twin attached to her cranium. After a week of extensive counselling and investigation, a successful separation operation was done. Postoperation, she comfortably suckled on the breast and had no neurological deficit. Two weeks after separation she was discharged in a good healthy condition with an arrangement for postnatal follow up.ConclusionsThe causes of craniopagus parasiticus are still unknown due to a rarity of cases and a limited number of studies on it. There have been only nine to ten cases of craniopagus parasiticus, of which only three survived past birth and were documented in the literature. Genetic scientists and researchers continue to investigate this case because they might find explanations for the birth defect, and provide answers to improve the prognosis and the life chances of twins with craniopagus parasiticus.

A rare case of craniopagus parasiticus delivered vaginally at a district hospital

“…Recently a few cases of craniopagus parasiticus have been successfully separated surgically and are surviving till date. 2,3,7 In this case the pregnant woman was antenatally diagnosed to have anencephaly with polyhydramnios and had an uneventful vaginal delivery at 35weeks 4 days of menstrual age. This centre being a district hospital (FRU) is not equipped with either pediatric surgery specialists or an intensive care set-up required for a separation procedure.…”

“…Another theory states that craniopagus is caused by lack of blood supply to the second twin due to degeneration of the umbilical cord. 2,6 Only 11 cases of craniopagus parasiticus have been reported so far in literature. 1,2,4 Most of these cases are still born.…”

“…2,6 Only 11 cases of craniopagus parasiticus have been reported so far in literature. 1,2,4 Most of these cases are still born. Recently a few cases of craniopagus parasiticus have been successfully separated surgically and are surviving till date.…”

“…Craniopagus Parasiticus is a rare type of parasitic twinning with an incidence of only 4-6/10,00,000 births. 1,2 Only 11 cases of Craniopagus Parasiticus have been reported in literature so far. [2][3][4] Most of the babies with Craniopagus Parasiticus are still born with only 4 cases in which the babies have survived after postpartum surgical separation.…”

A case of craniopagus parasiticus: an antenatal diagnosis by ultrasound screening at 16 weeks of gestation and a literature review of recently reported cases

“…Craniopagus parasiticus (CP) is a rare type of malformation of conjoined twins, with one degenerated or underdeveloped parasite twin united at the cranium with the other fully developed twin. 1,2 The term 'craniopagus' is a Greek word (kranio meaning 'head' and pagus meaning 'together'). 3 Only a handful of cases have been documented in the literature to date.…”