Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years

Muralidhar K. Pai, R. Chandrasekhar Naidu, A. Raja, Y. S. Rai, Niranjan Kumar, Anand Kini, Santhosh Joseph, Vinod Hegde, H. S. Ballal, Ramoorthi Rao, Saroja V. Sharma, Vinay Kumar Valakatte

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.

Original languageEnglish
Pages (from-to)426-433
Number of pages8
JournalNeurology India
Volume66
Issue number2
DOIs
Publication statusPublished - 01-03-2018

Fingerprint

Conjoined Twins
Skull
Critical Care
Scalp
Emergencies
Parturition
Exercise
Pediatrics

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Pai, Muralidhar K. ; Naidu, R. Chandrasekhar ; Raja, A. ; Rai, Y. S. ; Kumar, Niranjan ; Kini, Anand ; Joseph, Santhosh ; Hegde, Vinod ; Ballal, H. S. ; Rao, Ramoorthi ; Sharma, Saroja V. ; Valakatte, Vinay Kumar. / Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years. In: Neurology India. 2018 ; Vol. 66, No. 2. pp. 426-433.
@article{c50b64e43c1b413c8af3bbccac4f0a4f,
title = "Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years",
abstract = "Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6{\%} of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.",
author = "Pai, {Muralidhar K.} and Naidu, {R. Chandrasekhar} and A. Raja and Rai, {Y. S.} and Niranjan Kumar and Anand Kini and Santhosh Joseph and Vinod Hegde and Ballal, {H. S.} and Ramoorthi Rao and Sharma, {Saroja V.} and Valakatte, {Vinay Kumar}",
year = "2018",
month = "3",
day = "1",
doi = "10.4103/0028-3886.227289",
language = "English",
volume = "66",
pages = "426--433",
journal = "Neurology India",
issn = "0028-3886",
publisher = "Medknow Publications and Media Pvt. Ltd",
number = "2",

}

Pai, MK, Naidu, RC, Raja, A, Rai, YS, Kumar, N, Kini, A, Joseph, S, Hegde, V, Ballal, HS, Rao, R, Sharma, SV & Valakatte, VK 2018, 'Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years', Neurology India, vol. 66, no. 2, pp. 426-433. https://doi.org/10.4103/0028-3886.227289

Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years. / Pai, Muralidhar K.; Naidu, R. Chandrasekhar; Raja, A.; Rai, Y. S.; Kumar, Niranjan; Kini, Anand; Joseph, Santhosh; Hegde, Vinod; Ballal, H. S.; Rao, Ramoorthi; Sharma, Saroja V.; Valakatte, Vinay Kumar.

In: Neurology India, Vol. 66, No. 2, 01.03.2018, p. 426-433.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years

AU - Pai, Muralidhar K.

AU - Naidu, R. Chandrasekhar

AU - Raja, A.

AU - Rai, Y. S.

AU - Kumar, Niranjan

AU - Kini, Anand

AU - Joseph, Santhosh

AU - Hegde, Vinod

AU - Ballal, H. S.

AU - Rao, Ramoorthi

AU - Sharma, Saroja V.

AU - Valakatte, Vinay Kumar

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.

AB - Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.

UR - http://www.scopus.com/inward/record.url?scp=85044243127&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044243127&partnerID=8YFLogxK

U2 - 10.4103/0028-3886.227289

DO - 10.4103/0028-3886.227289

M3 - Article

AN - SCOPUS:85044243127

VL - 66

SP - 426

EP - 433

JO - Neurology India

JF - Neurology India

SN - 0028-3886

IS - 2

ER -