• Marion Walker and Samuel R Browd.
• Division of Pediatric Neurosurgery, Department of Neurosurgery, Health Sciences Center and Primary Children's Medical Center, University of Utah, Salt Lake City, UT, USA. marion.walker@hsc.utah.edu
• Childs Nerv Syst. 2004 Aug 1; 20 (8-9): 554-66.

IntroductionWith recent advances in brain imaging and neurosurgical techniques, there has been a renewed interest in the surgical separation of craniopagus twins. Successful separation in recent cases, along with widespread publicity, has attracted craniopagus twins from all over the world to be referred to pediatric neurosurgical centers for evaluation and consideration for surgical separation.Separation Of Blood SupplyIt has become apparent, however, that the most critical decisions in surgical planning are related to separation of the blood supply to the conjoined brains. In fact, in craniopagus twins that survive pregnancy or the first few days of life, there is usually little shared brain tissue. The shared blood supply is far and away the more critical issue. It is very difficult to successfully separate craniopagus twins in one surgical procedure. Staged separation, with gradual re-routing of the shared blood supply, has been a successful alternative.Case Studies And DiscussionWe discuss here our experience with three sets of craniopagus twins and our approach to staged separation.

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