Abstract
Objective
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.
Methods
Radiological investigations including cerebral angiography, magnetic resonance imaging and computerized tomographic scans were performed, leading to the diagnosis of total vertical craniopagus. There were two separate brains, with separate arterial circulations, but with a common superior sagittal sinus. Tissue expanders were inserted in the subgaleal space for 6 months of scalp expansion prior to surgery. Pre-operative planning involved the use of virtual reality equipment and life-sized polymer models of the conjoined skulls and brains. Surgical separation of the twins was achieved after approximately 100 h of operating time, using intraoperative image guidance, microsurgical techniques and intraoperative neurophysiologic monitoring. Reconstruction of the dura, calvarium and scalp was performed with artificial dura, absorbable plates and split skin grafts. Postoperative complications included focal cortical infarction, meningitis, and hydrocephalus.
Conclusion and outcome
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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Acknowledgements
The author would like to thank the following for their contributions to this case and this monograph: Dr Chumpon Chan, Dr Tang Kok Kee, Dr T. Rajendra, Dr Ong Biauw Chi, Dr Chee Huei Ling, Dr Claire Ang, Dr Ted Wong, Dr Vincent Yeow, Professor Lee Seng Teik, Dr Colin Song, Dr Tan Bien Kiem, Dr Andrew Tay, Dr Lim Shih Hui, Dr Lo Yew Long, Dr Winston Lim, Professor Tan Ser Kiat, Professor Vivian Balakrishnan, Dr Ralf Kockro, Dr Luis Serra, Professor Benjamin Carson.
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Goh, K.Y.C. Separation surgery for total vertical craniopagus twins. Childs Nerv Syst 20, 567–575 (2004). https://doi.org/10.1007/s00381-004-0978-3
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DOI: https://doi.org/10.1007/s00381-004-0978-3