• James Tait Goodrich and David A Staffenberg.
• Division of Pediatric Neurological Surgery, Center for Craniofacial Disorders at the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA. goodrich@aecom.yu.edu
• Childs Nerv Syst. 2004 Aug 1; 20 (8-9): 618-24.

Case ReportWe present the case of 2-year-old craniopagus twins who are in the process of undergoing a staged separation of their craniums. In addition, they will undergo a full calvarial vault remodeling to reconstruct the lacking skull and scalp tissue in each child. We elected to do a staged separation rather than a single marathon operation for various reasons, which we will detail in this report.DiscussionThe philosophy and surgical management of each step will be discussed along with the pros and cons behind the reasoning that was used. At the time of this report the children have undergone three of what are projected to be four stages of separation. Each of the stages has had unique characteristics and surgical judgments involved, and those will be reviewed.ConclusionSuccessful separation of viable conjoined twins has been historically a great rarity. Successful separation of twins where both have come out of surgery without any neurological deficit remains a rare occurrence and in our mind the ultimate goal.

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