Craniopagus: second Brisbane case

Campbell, Scott; Theile, Richard; Stuart, Gordon; McDonald, Matthew J.; Sinnott, Stephen; Frawley, Kieran; Wilson, John; Isles, Alan

doi:10.3171/ped.2004.100.5.0519

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Following mapping and imaging, model surgery is a critical portion of surgical preparation. The value of stereolithographically constructed polymer models has been previously reported and serves as an aid in preoperative planning (Campbell et al, 2002; Campbell et al, 2004; Christensen et al, 2004; Goh, 2004; Goodrich and Staffenberg, 2004; Rutka et al, 2004; Swift et al, 2004; Staffenberg and Goodrich, 2005; Kho et al, 2012). These models are of value in the design of scalp flaps and placement of tissue expanders relative to the anticipated craniotomies.…”

Section: Discussionmentioning

confidence: 99%

Eleven-Year Follow-Up of Craniopagus Twins After Unsuccessful Attempt at Separation: Are They Better Off?

Harvey

Vaca

Totonchi

et al. 2019

The Cleft Palate-Craniofacial Journal

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Craniopagus twins are a rare phenomenon and present numerous challenges in separation. Due to the paucity of data, it is paramount to evaluate outcomes based on case studies to continue improving medical and surgical management of these patients. We present a case report of craniopagus twins cared for by the senior author (A.K.G.). The patients underwent extensive surgical planning and 2 attempts at cerebroendovascular embolization to reroute shared venous sinus drainage. After the 2 endovascular procedures, attempted separation at age 41 months was aborted due to intraoperative hemodynamic instability. Eleven-year follow-up shows the twins to be developing well in regard to social and cognitive development. Nonetheless, they have had numerous physical challenges including a fall in 2016 resulting in C1-C2 subluxation in twin B leading to partial spinal cord ischemia and left-sided weakness. The separation of craniopagus twins is fraught with technical, medical, and ethical challenges. Surgical separation of the twins is not always possible without significant risk of devastating consequences to one or both twins. Follow-up of the twins 11 years later raises the question: are some craniopagus twins better off without separation?

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Section: Discussionmentioning

confidence: 99%

Eleven-Year Follow-Up of Craniopagus Twins After Unsuccessful Attempt at Separation: Are They Better Off?

Harvey

Vaca

Totonchi

et al. 2019

The Cleft Palate-Craniofacial Journal

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“…Death of one of twins during craniopagus twin separation surgery: Of 30 CPT separation attempts in the past century, one twin died in 4 twin set surgeries. Of 32 CPT separation attempts in the past 20 years, one twin died in 9 CPT cases (in 4 cases, death resulted from intraoperative massive blood loss and directional venous drainage/shunting, in 3 cases, one twin died before surgery because of other congenital cardiac/renal anomalies, and in 2 cases, cause of death not reported) 16,28-53 (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Careful case selection for surgery, routine use of 3D print brain and skull models, simulation software, neuronavigation assistance, intraoperative adjuncts/tools, endovascular interventions, innovative surgical methods (distraction osteogenesis), multistage surgeries, and advanced perioperative intensive care availability enable better outcomes. Over the past 20 years, both twins survived in 21 of 32 separation attempts (65.6%) compared with 12 of 30 separation earlier (40%) 16,28-53 (Table 1).…”

Section: Discussionmentioning

confidence: 99%

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

et al. 2022

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Craniopagus conjoined twins are extremely rare, reported 1 in 2.5 million live births. To date, 62 separation attempts in 69 well-documented cases of craniopagus twins have been made. Of these, 34 were performed in a single-stage approach, and 28 were attempted in a multistage approach. One or both twins died of massive intraoperative blood loss and cardiac arrest in 14 cases. We report our surgical experience with conjoined craniopagus twins (JB) with type III total vertical joining and shared circumferential/circular sinus with left-sided dominance. A brief review of the literature is also provided. In our twins, the meticulous preoperative study and planning by the multidisciplinary team consisting of 125-member, first-staged surgical separation consisted of creation of venous conduit to bypass part of shared circumferential sinus and partial hemispheric disconnection. Six weeks later, twin J manifested acute cardiac overload because of one-way fistula development from blocked venous bypass graft necessitating emergency final separation surgery. Unique perioperative issues were abnormal anatomy, hemodynamic sequelae from one-way fistula development after venous bypass graft thrombosis, cardiac arrest after massive venous air embolism requiring prolonged cardiopulmonary resuscitation, and return of spontaneous circulation at 15 minutes immediately after separation. This is the first Indian craniopagus separation surgery in a complex total vertical craniopagus twin reported by a single-center multidisciplinary team. Both twins could be sent home, but one remained severely handicapped. Adequate perioperative planning and multidisciplinary team approach are vital in craniopagus twin separation surgeries.

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“…Therefore, only a few successful case reports of separation of craniopagus-type conjoined twins have been reported. 2–10 Modern neurosurgical and neurovascular techniques have created opportunities for successful separation and the promise of a normal existence for these children. Craniopagus conjoined twins can present with shared brain tissue, arterial supply and venous drainage, with defects in the skull and dura.…”

Section: Introductionmentioning

confidence: 99%

Neurointerventional participation in craniopagus separation

et al. 2015

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Craniopagus-type conjoined twins (joined at the head) are exceedingly rare. Separation of craniopagus conjoined twins is a challenging task mainly owing to complex vascular anatomy and limited experience with this disorder. Modern neuroimaging techniques including digital subtraction angiography can be used to preoperatively assess the cerebral vascular system. These techniques can also provide the raw data to fabricate three-dimensional true-scale models. We report a case in which endovascular techniques have been used in the separation of craniopagus conjoined twins. To our knowledge there are no reports of successful incorporation of neurointerventional methods in the disconnection of shared venous channels.

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Craniopagus: second Brisbane case

Cited by 6 publications

References 6 publications

Eleven-Year Follow-Up of Craniopagus Twins After Unsuccessful Attempt at Separation: Are They Better Off?

Eleven-Year Follow-Up of Craniopagus Twins After Unsuccessful Attempt at Separation: Are They Better Off?

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

Neurointerventional participation in craniopagus separation

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