Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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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.
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Craniopagus twinning is a rare embryological event occurring in 1 in 2.5 million births. ⋯ The separation of craniopagus twins demands a multidisciplinary team approach. Utilizing preoperative neuroendovascular techniques to occlude shared vascular anastomotic channels, complex total vertical craniopagus twins can now be successfully separated in a one-stage procedure.
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There are many problems facing the neurosurgeon when separating craniopagus twins. The condition is rare, with an incidence of 1 in 2.5 million births. As such there is a paucity of information in the literature regarding strategies for separation. ⋯ The aim of this article is to discuss the preoperative work-up, technical details of surgery, postoperative care and lessons learned with respect to the separation of craniopagus twins.
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Comparative Study Clinical Trial
Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis.
The current study was performed to determine the rate of allogeneic blood transfusion for coronal and metopic craniosynostosis surgery done by two experienced pediatric neurosurgeons and to identify factors associated with a need for transfusion. ⋯ Low transfusion rates were achieved in primary operations for coronal and metopic craniosynostosis using simple intraoperative techniques and by accepting a low postoperative hemoglobin level.
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Cauda equina syndrome with sphincter dysfunction is an uncommon and feared complication of lumbar disc herniation. ⋯ Lumbar disc disease in the pediatric age has been reported infrequently, but to the best of our knowledge, this is the first pediatric case of acute lumber disc herniation presenting with caudal compression.