Successful multistaged operative separation of 3-year-old craniopagus twins in a multidisciplinary, international collaboration

Pataki, Gergely; Hudák, István; Valálik, István; Czeibert, Kálmán; Csapody, Marcell; Jósvai, Attila; Fekete, Attila; Kalam, Abul; Hossain, I.; Hasan, Masroor; Salek, Al Amin; Islam, Shafiqul; Csókay, András

doi:10.1016/j.surg.2020.04.025

Cited by 5 publications

(6 citation statements)

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“…Advanced neuroimaging and endovascular interventions for shared venous sinus have improved outcomes recently. 2,3,15,21…”

Section: Discussionmentioning

confidence: 99%

“…7,49 Destructive techniques for occlusion of the shared sinus/venous connections along the planned surgical path may be performed to isolate the venous drainage of the twins. 23 Pataki et al 15 used the ethyl vinyl alcohol copolymer to obliterate the circumferential sinus before separation. Endovascular embolization of the circumferential sinus was not performed in our case anticipating high contrast burden for a prolonged endovascular procedure.…”

Section: Discussionmentioning

confidence: 99%

“…13 To date, 62 separation attempts in 69 well-documented cases of craniopagus have been made (34 were performed in a single-stage approach, and 28 were attempted in a multiple-stage approach). 14,15 Philosophy of treating CPT has evolved from nihilism (twins allowed to die at birth, offering no surgery to operable cases citing high risk of morbidity/mortality) to optimism (attempting surgical separation in operable cases).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Advanced neuroimaging and endovascular interventions for shared venous sinus have improved outcomes recently. 2,3,15,21 One twin is anatomically predisposed to keep the circular venous sinus (CVS) along with its dural shelf and the transverse dural septum. With the increasing intertwin angle, CVS may assume an oblique configuration.…”

Section: Multistage (Multiple Surgeries)mentioning

confidence: 99%

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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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“…Advanced neuroimaging and endovascular interventions for shared venous sinus have improved outcomes recently. 2,3,15,21…”

Section: Discussionmentioning

confidence: 99%