Craniopagus twins for magnetic resonance imaging

Vagyannavar, Raghavendra; Bhattacharyya, Amrita; Misra, Gaurav; Hashim, Mohammad; Asmita,

doi:10.4103/sja.sja_89_17

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…Another modality that can be used is magnetic resonance imaging (MRI), which offers enhanced precision in providing anatomically detailed radiological images compared to ultrasound. [12][13][14] In the present case, a prenatal ultrasound assessment is performed during the 17th to 18th weeks of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

Aditiawarman

2024

MOG

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HIGHLIGHTS Conjoined twins have captivated mankind for centuries due to the rarity of this birth type; nonetheless, physicians have constantly encountered difficulties in dealing with conjoined twins. Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy. First-trimester ultrasonography and MRI are complementary modalities in determining the diagnosis and prognosis of conjoined twins in early pregnancy. ABSTRACT Objectives: To discuss the crucial early diagnosis of conjoined twins to determine the type and prognosis. Case Report: A 27-year-old woman was referred to the type A referral hospital with suspicion of congenital abnormalities at 17 weeks of pregnancy. Ultrasound results showed intrauterine monochorionic monoamniotic twins with babies fused on their heads to the urogenital part. The MRI showed a craniopagus, suspected meningomyelocele, and severe bilateral hydronephrosis in the second baby. Due to non-separable cases and a bad prognosis for the fetus, the pregnancy was terminated using misoprostol induction and inserting a balloon catheter. The fetus is born weighing 400 g and 20 cm in length. Conjoined twins obtained the rostral type: a fused head with two faces, a fused thorax until the lower abdomen with one umbilicus, and two pairs of hands and feet. The diagnosis of conjoint twins becomes a problem in early pregnancy, mostly in developing countries. Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy to prevent maternal stress and complications. Conclusion: Conjoined twins should be identified as soon as feasible to establish the best course of management for both mother and fetus. Ultrasonography and MRI are modalities for determining the diagnosis and prognosis of conjoined twins.

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Section: Discussionmentioning

confidence: 99%

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

Aditiawarman

2024

MOG

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“…There is a paucity of literature on the use of monitored sedation in conjoined twins. One correspondence article describes a sedation technique in 6‐month‐old craniopagus twins for magnetic resonance imaging using triclofos as premedication, with intermittent boluses of propofol to limit movement during imaging [4]. Chloral hydrate has also been used.…”

Section: Figurementioning

confidence: 99%

Dexmedetomidine sedation for radiological imaging in conjoined twins

Khan,

Shamim,

Ghaffar

et al. 2024

Anaesthesia Reports

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“…Neuroanesthesia involvement is essential, using a dedicated team of anesthesiologists and equipment for each child, with closed-loop communication between teams to avoid confusion and drug errors and strict labeling of the twins to avoid confusion between them while dosing medications. 58,59 Pharmacokinetics and pharmacodynamics in CPT are altered due to circulatory mixing, and medications administered to one twin may have unexpected effects on the other. 60 Mask ventilation, access to airway, and intubation are also difficult due to the angle between the heads.…”

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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Craniopagus twins for magnetic resonance imaging

Cited by 8 publications

References 9 publications

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

Dexmedetomidine sedation for radiological imaging in conjoined twins

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

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