Craniopagus twins

Gaist, G; Piazza, G; Galassi, Ercole; Cavina, C; Gp, Salvioli

doi:10.1007/bf00270702

Cited by 13 publications

(1 citation statement)

References 14 publications

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“…Multiple classification systems have been proposed for CPT (On-line Table ). 3,4,21,25,28 The first was developed by O'Connell, 29 in which CPT were classified as partial or total; total CPT share an extensive surface area with widely connected cranial cavities, while in partial CPT, only a limited, superficial surface area is affected. He subdivided partial craniopagus twins on the basis of the degree of rotation of one head in relation to the other, with different deformities of the brain and abnormal circulation for each.…”

Section: Classification Systemsmentioning

confidence: 99%

Preoperative Evaluation of Craniopagus Twins: Anatomy, Imaging Techniques, and Surgical Management

Goldman‐Yassen

Goodrich

Miller

et al. 2020

AJNR Am J Neuroradiol

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Craniopagus twins are a rare congenital malformation in which twins are conjoined at the head. Although there is high prenatal and postnatal mortality for craniopagus twins, successful separation has become more common due to advances in neuroimaging, neuroanesthesia, and neurosurgical techniques. Joined brain tissue, shared arteries and veins, and defects in the skull and dura make surgery technically challenging, and neuroimaging plays an important role in preoperative planning. Drawing on our experience from consultation for multiple successful separations of craniopagus twins, we discuss what radiologists need to know about the anatomy, classification, imaging techniques, and surgical management of craniopagus twins. ABBREVIATIONS: CPT ¼ craniopagus twins; CVS ¼ circumferential venous sinus; SDVS ¼ shared dural venous sinuses; TA ¼ total angular; TV ¼ total vertical C raniopagus twins (CPT) are a rare congenital malformation in which twins are conjoined at the head. It accounts for only 2%-6% of conjoined twins, with an incidence of approximately 1 in 2.5 million lives births. 1,2 The skulls are most often joined at homologous regions on each twin in both vertical and angular orientations, with the face and foramen magnum not primarily involved. 3 CPT can manifest as total, the twins share dural venous sinuses (SDVS), and partial forms, with separate venous anatomy. 4 Although there is high prenatal and postnatal mortality for CPT, successful separation has become more common due to advances in neuroimaging, neuroanesthesia, and neurosurgical techniques. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Joined brain tissue, shared arteries and veins, and defects in the skull and dura make surgery technically challenging. 21 Separation can take place in single or multistage procedures and has evolved as the understanding of the physiology, surgical techniques, and technology of CPT have improved. 16 Neuroimaging, including CT, MR imaging, and conventional angiography, plays an important role in mapping the shared arterial and venous structures, brain parenchyma, calvaria, and dura. [22][23][24] Understanding the shared vascular anatomy is important for surgical planning because separating common vessels is associated with complications such as thrombosis, air embolism, infarction, and hemorrhage. 25 Digital and physical 3D models generated from CT and MR imaging data are important tools for operative planning and as a guide in the operating room. 21 We will review the preoperative radiologic evaluation of CPT, including the anatomy, classification systems, and surgical management, that is important for the radiologist to understand. We draw on our experience in consultation for multiple successful CPT separations with an experienced neurosurgical specialist in CPT.

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