Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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We 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. ⋯ Successful 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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Review Case Reports
Ischiopagus and pygopagus conjoined twins: neurosurgical considerations.
Neurosurgeons are familiar with the challenges presented by craniopagus twins, but other types of conjoined twins may also have neurosurgical implications. We report our experience in the management of ischiopagus and pygopagus conjoined twins. ⋯ Ischiopagus and pygopagus conjoined twins manifest an interesting array of spinal abnormalities, which present challenges, not only at the time of separation, but also in their long-term management.
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Review Case Reports
Craniopagus twins: embryology, classification, surgical anatomy, and separation.
With 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. ⋯ We discuss here our experience with three sets of craniopagus twins and our approach to staged separation.
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Anaesthesia for conjoined twin surgery, whether prior to or for separation, is an enormous challenge to the paediatric anaesthesiologist. ⋯ The site and complexity of the conjunction will affect airway management, acquisition of vascular access, the extent of blood loss, and the number of surgical specialties involved. Preoperative assessment and planning, with interdisciplinary communication and cooperation, is vital to the success of the operations. These twins require a dedicated team of anaesthetists for each child, and, consequently, duplication of all monitoring and equipment in one operating room is necessary. Meticulous attention to detail, monitoring, and vigilance are mandatory. Planning for the postoperative period in the intensive care unit (ICU), as well as the babies' reconstruction and rehabilitation, is essential from the time of the initial admission.
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A pair of conjoined twins aged 11 months underwent investigations, followed by surgical separation in Singapore General Hospital in April 2001. They were joined at the skull vertex and facing in opposite directions. ⋯ Despite these complications, the twins recovered satisfactorily and were discharged to their home country within 6 months. The 3-month outcome was minor disability in one twin and severe developmental delays in the other. Separation surgery is possible for complex cranially-conjoined twins but requires detailed planning and extensive surgical management.