Neurointerventional participation in craniopagus separation

Alokaili, Riyadh; Ahmed, Muhammad Ejaz; Feryan, Ahmed Al; Goodrich, James Tait; Aloraidi, Ahmed

doi:10.1177/1591019915590313

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…Endovascular disconnections of targeted vascular channels crossing the surgically planned path of separation as an adjunct to surgery are feasible. 15,22 The surgical strategy in such cases is to let the twin with better prospect of survival keep the CVS, whereas the superficial venous channels draining from other twin to the CVS are disconnected in staged surgeries to facilitate collateral development.…”

Section: Multistage (Multiple Surgeries)mentioning

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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Section: Multistage (Multiple Surgeries)mentioning

confidence: 99%

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

et al. 2022

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“…Other types of shared venous drainage include venous sinus "lakes," a single shared superior sagittal sinus, or separate superior sagittal sinuses with variable interconnections between them. 24,29,46 The nature of the cerebral venous system is an important prognostic indicator of successful separation because complications during separation can lead to substantial blood loss and a catastrophic result for 1 or both children. 7 Both the CVS and SDVS are always present in TV forms of CPT, making successful surgical separation particularly hazardous.…”

Section: Partial Cptmentioning

confidence: 99%

“…20,67 Embolization of venous structures has also been described to promote the development of collaterals and facilitate an easier surgical venous separation. 24,67 Coil embolization has also been used in the case of shared arterial supply. 42…”

Section: Angiographymentioning

confidence: 99%

“…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.…”

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confidence: 99%

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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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“…Goodrich's other notable publications in this field described the history, epidemiology, novel comprehensive classification scheme, neuroimaging techniques, surgical indications, risk and complications assessment, advanced surgical approaches and operating room tactics, and other notable subsequent cases. 2,11,40,41…”

Section: Goodrich's Scientific Contributions To Craniopagus Surgerymentioning

confidence: 99%

James T. Goodrich, MD, PhD, 1946–2020: a historical perspective and his contributions to craniopagus separation

Lehrich

Brown

Shahrestani

et al. 2020

Journal of Neurosurgery: Pediatrics

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Dr. James Tait Goodrich was an internationally renowned pediatric neurosurgeon who pioneered the neurosurgical procedures for the multistage separation of craniopagus twins. As of March 2020, 59 craniopagus separations had been performed in the world, with Goodrich having performed 7 of these operations. He was the single most experienced surgeon in the field on this complex craniofacial disorder. Goodrich was a humble individual who rapidly rose through the ranks of academic neurosurgery, eventually serving as Director of the Division of Pediatric Neurosurgery at the Children’s Hospital at Montefiore Medical Center in the Bronx, New York. In this historical vignette, the authors provide context into the history of and sociocultural attitudes toward conjoined twins; the epidemiology and classification of craniopagus twins; the beginnings of surgery in craniopagus twins; Goodrich’s neurosurgical contributions toward advancing treatment for this complex craniofacial anomaly; and vignettes of Goodrich’s unique clinical cases that made mainstream news coverage.

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Neurointerventional participation in craniopagus separation

Cited by 12 publications

References 17 publications

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

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

James T. Goodrich, MD, PhD, 1946–2020: a historical perspective and his contributions to craniopagus separation

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