Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Emergency Separation of Craniopagus Twins: Case Report Publisher Pubmed



Nejat F1 ; Habibi Z1 ; Goudarzi M2 ; Azad MS3 ; Moradi E1 ; Heidari V1 ; Kadivar M4 ; Soltani ZE1 ; Kouchakzadeh L5
Authors
Show Affiliations
Authors Affiliations
  1. 1. Department of Neurosurgery, Children's Hospital Medical Center, Gharib St., Tehran, 14155-7854, Iran
  2. 2. Department of Anesthesiology, Iran
  3. 3. Sina Hospital, Tehran University of Medical Science, Tehran, Iran
  4. 4. Department of Neonatology, Iran
  5. 5. Department of Pediatrics, Children's Medical Center, Tehran University of Medical Science, Iran

Source: Journal of Neurosurgery: Pediatrics Published:2017


Abstract

Craniopagus is a very rare congenital anomaly that tends to affect females more often than males. It is classifed as partial or total. Most affected twins are either stillborn or die during the perinatal period. Those who survive birth should undergo detailed radiological evaluations soon after their condition becomes stable so that the precise anatomy of the conjoined part can be defned and surgery can be planned in detail by a multidisciplinary team. Recommendations for decreasing the risk of unsuccessful surgery include performing surgery on an elective basis after extensive preoperative radiological evaluations as well as when the twins are at an acceptable age and weight for a complex surgical separation, generally as staged procedures. In addition, the operation should be performed by a well-equipped expert multidisciplinary team. When one of the conjoined twins dies, however, surgical separation cannot be postponed because the shared circulatory system predisposes the alive child to life-threatening complications, including coagulopathy. The authors report on the successful separation of craniopagus twins performed on an emergency basis at 32 weeks of gestational age because of the sudden death of one of them. At the time of separation surgery, the twins each weighed 1250 g. To the best of the authors' knowledge, this is the youngest age and lowest weight yet reported for successful surgical separation. The surviving twin developed a pseudomeningocele, which required a second operation and placement of a cystoperitoneal shunt 4 months after the operation. Additional surgery is planned to repair a cranial defect that resulted from the pseudomeningocele, but his general physical and mental condition was otherwise good at latest follow-up (12 months after separation surgery). © 2017 AANS.