Total Craniopagus Twins

Abstract

The frequency of craniopagus twins is very low and so far only 32 cases have been reported in the literature. Most of authors give a frequency of 1 in 2.5 million births, although, since numerous cases are not reported, it is probable that the occurrence is greater than this figure indicates. A new case of conjoined twins by the head is presented.

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

“…Careful case selection for surgery, routine use of 3D print brain and skull models, simulation software, neuronavigation assistance, intraoperative adjuncts/tools, endovascular interventions, innovative surgical methods (distraction osteogenesis), multistage surgeries, and advanced perioperative intensive care availability enable better outcomes. Over the past 20 years, both twins survived in 21 of 32 separation attempts (65.6%) compared with 12 of 30 separation earlier (40%) 16,28-53 (Table 1).…”

“…Death of one of twins during craniopagus twin separation surgery: Of 30 CPT separation attempts in the past century, one twin died in 4 twin set surgeries. Of 32 CPT separation attempts in the past 20 years, one twin died in 9 CPT cases (in 4 cases, death resulted from intraoperative massive blood loss and directional venous drainage/shunting, in 3 cases, one twin died before surgery because of other congenital cardiac/renal anomalies, and in 2 cases, cause of death not reported) 16,28-53 (Table 1).…”

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

“…Careful case selection for surgery, routine use of 3D print brain and skull models, simulation software, neuronavigation assistance, intraoperative adjuncts/tools, endovascular interventions, innovative surgical methods (distraction osteogenesis), multistage surgeries, and advanced perioperative intensive care availability enable better outcomes. Over the past 20 years, both twins survived in 21 of 32 separation attempts (65.6%) compared with 12 of 30 separation earlier (40%) 16,28-53 (Table 1).…”

“…Death of one of twins during craniopagus twin separation surgery: Of 30 CPT separation attempts in the past century, one twin died in 4 twin set surgeries. Of 32 CPT separation attempts in the past 20 years, one twin died in 9 CPT cases (in 4 cases, death resulted from intraoperative massive blood loss and directional venous drainage/shunting, in 3 cases, one twin died before surgery because of other congenital cardiac/renal anomalies, and in 2 cases, cause of death not reported) 16,28-53 (Table 1).…”

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

“…9,29,47 Total Angular CPT Total angular (TA) CPT have more acute intertwin longitudinal angulation and SDVS accompanied by complex, interconnecting venous channels (or CVS) and markedly distorted cerebral hemispheres. [48][49][50][51][52] One twin's brain can be inside the other twin's calvaria, adding additional to the complexity of the surgical separation. Cerebral compaction, distortion, and displacement may result in skull base deformity.…”

Anesthetic Management for a Five-Day Separation of Craniopagus Twins

“…The incidence is estimated at 1 per 2.5 million live births (1). The anesthetic management of these cases is sparse (2,3).…”

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

“…Careful case selection for surgery, routine use of 3D print brain and skull models, simulation software, neuronavigation assistance, intraoperative adjuncts/tools, endovascular interventions, innovative surgical methods (distraction osteogenesis), multistage surgeries, and advanced perioperative intensive care availability enable better outcomes. Over the past 20 years, both twins survived in 21 of 32 separation attempts (65.6%) compared with 12 of 30 separation earlier (40%) 16,28-53 (Table 1).…”

“…Death of one of twins during craniopagus twin separation surgery: Of 30 CPT separation attempts in the past century, one twin died in 4 twin set surgeries. Of 32 CPT separation attempts in the past 20 years, one twin died in 9 CPT cases (in 4 cases, death resulted from intraoperative massive blood loss and directional venous drainage/shunting, in 3 cases, one twin died before surgery because of other congenital cardiac/renal anomalies, and in 2 cases, cause of death not reported) 16,28-53 (Table 1).…”

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

“…9,29,47 Total Angular CPT Total angular (TA) CPT have more acute intertwin longitudinal angulation and SDVS accompanied by complex, interconnecting venous channels (or CVS) and markedly distorted cerebral hemispheres. [48][49][50][51][52] One twin's brain can be inside the other twin's calvaria, adding additional to the complexity of the surgical separation. Cerebral compaction, distortion, and displacement may result in skull base deformity.…”

Anesthetic Management for a Five-Day Separation of Craniopagus Twins

“…The incidence is estimated at 1 per 2.5 million live births (1). The anesthetic management of these cases is sparse (2,3).…”

A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism

“…Careful case selection for surgery, routine use of 3D print brain and skull models, simulation software, neuronavigation assistance, intraoperative adjuncts/tools, endovascular interventions, innovative surgical methods (distraction osteogenesis), multistage surgeries, and advanced perioperative intensive care availability enable better outcomes. Over the past 20 years, both twins survived in 21 of 32 separation attempts (65.6%) compared with 12 of 30 separation earlier (40%) 16,28-53 (Table 1).…”

“…Death of one of twins during craniopagus twin separation surgery: Of 30 CPT separation attempts in the past century, one twin died in 4 twin set surgeries. Of 32 CPT separation attempts in the past 20 years, one twin died in 9 CPT cases (in 4 cases, death resulted from intraoperative massive blood loss and directional venous drainage/shunting, in 3 cases, one twin died before surgery because of other congenital cardiac/renal anomalies, and in 2 cases, cause of death not reported) 16,28-53 (Table 1).…”

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

“…9,29,47 Total Angular CPT Total angular (TA) CPT have more acute intertwin longitudinal angulation and SDVS accompanied by complex, interconnecting venous channels (or CVS) and markedly distorted cerebral hemispheres. [48][49][50][51][52] One twin's brain can be inside the other twin's calvaria, adding additional to the complexity of the surgical separation. Cerebral compaction, distortion, and displacement may result in skull base deformity.…”

Anesthetic Management for a Five-Day Separation of Craniopagus Twins

“…The incidence is estimated at 1 per 2.5 million live births (1). The anesthetic management of these cases is sparse (2,3).…”