Anesthetic management of craniopagus conjoined twins in a remote location

Yadav, Monu; Chikkala, Ramakrishnaprasad; Kulkarni, Dilip Kumar; Gopinath, R.

doi:10.4103/sja.sja_288_17

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…To the authors' knowledge, this is the first reported case of surgical treatment of traumatic craniocervical deformity causing SCI in craniopagus twins. Existing literature, both historical and contemporary, is limited to discussions of surgical technique for separation, 1,16, 18-23, 27, 28, 30, 31, 33, 35-37,39 perioperative anesthetic management, 17,[24][25][26][40][41][42] ethical considerations for surgery, 1,15 and anatomical factors contributing to the development of craniopagus. [3][4][5][6][7]12 Endeavoring to operate on craniopagus twins requires a myriad of logistical, technical, and ethical challenges be addressed, as well as development of a coordinated care team comprising surgeons, anesthesiologists, pediatric intensivists, nurses, chaplains, ethicists, and the patients' family.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins

Wemhoff¹,

Swong²,

Li³

et al. 2020

Journal of Neurosurgery: Spine

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A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1–2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.

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Section: Discussionmentioning

confidence: 99%

Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins

Wemhoff¹,

Swong²,

Li³

et al. 2020

Journal of Neurosurgery: Spine

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“…60 Mask ventilation, access to airway, and intubation are also difficult due to the angle between the heads. 61 During imaging, it is ideal to position the twins in the position planned for surgery. This helps the surgeons become oriented to the structures as they would appear on the table during surgery.…”

Section: Sedation Considerationsmentioning

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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