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Poudel D, Shrestha S, Aryal R, Adhikari A, Bajracharya S. Thoraco-omphalopagus conjoined twin: A rare case report. Int J Surg Case Rep 2022; 99:107683. [PMID: 36137433 PMCID: PMC9568746 DOI: 10.1016/j.ijscr.2022.107683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Conjoined twins epitomize rare phenomenon of monozygotic twinning. Associated with high rates of stillbirth and neonatal demise Recommended mode of delivery is cesarean section. Thoraco-omphalopagus linked with poorer prognosis due to complex cardiac, hepatic and biliary fusion
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Conjoined Twins: Unicephalus Non-Janiceps Tetrapus Tetrabrachius. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-022-00342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Gupta D, Kedia S, Rath GP, Pandia MP, Chauhan S, Sharma R, Raheja A, Darbari S, Kamra D, Malik V, Saxena A, Hote M, Lodha R, Gulati S, Jauhari P, Sankar J, Sinha A, Bagga A, Kapil A, Singhal M, Chauhan S, Tiwari R, Prabhakar A, Gaikwad SB, Takizawa K, Sabapathy SR, Mazzeo AT, Jaryal A, Kale SS, Mahapatra AK. A Century With Craniopagus Twin Separation Surgeries: Nihilism to Optimism. Neurosurgery 2022; 91:27-42. [PMID: 35506944 DOI: 10.1227/neu.0000000000001962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
Craniopagus conjoined twins are extremely rare, reported 1 in 2.5 million live births. To date, 62 separation attempts in 69 well-documented cases of craniopagus twins have been made. Of these, 34 were performed in a single-stage approach, and 28 were attempted in a multistage approach. One or both twins died of massive intraoperative blood loss and cardiac arrest in 14 cases. We report our surgical experience with conjoined craniopagus twins (JB) with type III total vertical joining and shared circumferential/circular sinus with left-sided dominance. A brief review of the literature is also provided. In our twins, the meticulous preoperative study and planning by the multidisciplinary team consisting of 125-member, first-staged surgical separation consisted of creation of venous conduit to bypass part of shared circumferential sinus and partial hemispheric disconnection. Six weeks later, twin J manifested acute cardiac overload because of one-way fistula development from blocked venous bypass graft necessitating emergency final separation surgery. Unique perioperative issues were abnormal anatomy, hemodynamic sequelae from one-way fistula development after venous bypass graft thrombosis, cardiac arrest after massive venous air embolism requiring prolonged cardiopulmonary resuscitation, and return of spontaneous circulation at 15 minutes immediately after separation. This is the first Indian craniopagus separation surgery in a complex total vertical craniopagus twin reported by a single-center multidisciplinary team. Both twins could be sent home, but one remained severely handicapped. Adequate perioperative planning and multidisciplinary team approach are vital in craniopagus twin separation surgeries.
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Affiliation(s)
- Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Kedia
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Girija Prasad Rath
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Mihir Prakash Pandia
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shaurya Darbari
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devasheesh Kamra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Milind Hote
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Jauhari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Chauhan
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Tiwari
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Prabhakar
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Anna Teresa Mazzeo
- Department of Adult and Pediatric Pathology, University of Messina, Messina, Italy
| | - Ashok Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Singhal M, Sabapathy SR, Gupta D, Mahapatra AK, Chauhan S, Tiwari R, Venkatramani H, Kedia S, Saha S, Sahu SAA, Dash S, Sodhi M. First Successful Separation of Craniopagus Twins in India—Plastic Surgical Considerations. Indian J Plast Surg 2022; 55:36-44. [PMID: 35444747 PMCID: PMC9015846 DOI: 10.1055/s-0041-1740406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.
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Affiliation(s)
- Maneesh Singhal
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | | | - Deepak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Chauhan
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Raja Tiwari
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Hari Venkatramani
- Division of Plastic, Hand, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Shweta Kedia
- All India Institute of Medical Sciences, New Delhi, India
| | - Shivangi Saha
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | | | - Suvashis Dash
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
| | - Megha Sodhi
- Department of Plastic Reconstructive and Burns Surgery, Burns & Plastic Surgery Block, All India Institute of Medical Sciences New Delhi, India
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Ribeiro G, Werner H, Lopes J, Castro P, Araujo Júnior E. Craniopagus twin: pre- and post-natal 3-dimensional virtual and physical models and virtual navigation created with free or open source software-an option for low-resource centers. Childs Nerv Syst 2021; 37:2651-2655. [PMID: 33929582 DOI: 10.1007/s00381-021-05160-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Craniopagus twins represent a rare and complex congenital malformation characterized by conjoined twins fused at the cranium. Craniopagus is challenging for patients' families and surgeons, and accurate confirmation of the extent of cranial fusion is a complex process. Most information regarding the surgical anatomy of this rare condition is obtained through analysis of ultrasonographic, magnetic resonance, or computed tomographic images. A multidisciplinary team plays a key role in obtaining such information and in parental counseling and coordination of various complex processes for optimal postnatal care of these twins. The extent of fusion is usually determined based on conventional clinical methods, such as imaging studies. METHODS Imaging software is being used in recent times to create three-dimensional reconstruction images and for virtual navigation to investigate the skulls and brains of craniopagus twins. However, the acquisition and maintenance costs of such sophisticated medical software may be unaffordable for medical centers in developing countries. To overcome this limitation, we investigated the role of open or free source software for accurate determination of complex malformations of the skull and brain of craniopagus twins.
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Affiliation(s)
- Gerson Ribeiro
- Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Jorge Lopes
- Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Pedro Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil.,Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, CEP, São Paulo, SP, 05089-030, Brazil. .,Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, SP, Brazil.
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Caceres A, Segura-Masis JL, Caceres-Alan A, Gutierrez-Duran F, Zamora-Chaves J, Segura-Valverde JL. Craniopagus parasiticus: successful separation of a 28-week preterm newborn from parasite sibling twin bearing lethal congenital anomalies associated to Cantrell's pentad and sirenomelia-case-based review of the literature. Childs Nerv Syst 2021; 37:2139-2146. [PMID: 33934204 DOI: 10.1007/s00381-021-05179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper reviews the plausible etiological mechanisms, clinical features, preoperative analysis, and documented modern-day craniopagus parasiticus surgical separation attempts as well as an historical review of the few cases documented in the literature. METHODS We describe the successful separation of a 28-week preterm newborn from its parasite sibling twin bearing lethal congenital anomalies associated to Cantrell's pentad and sirenomelia. Description of the case, plausible explanations on the mechanisms of conjointment along with the associated congenital abnormalities of the deceased twin are examined along with an historical revision of craniopagus parasiticus and their separation attempts with special attention to the previously undocumented attempt of the Dominican CP separation surgery by Lazareff et al. RESULTS: The use of the deceased twin cranial vault tissues (skin, bone, and duramater) as an autologous implant due to the identical genetical profile served to remodel and close the skull of the surviving twin with good esthetic results and no tissue rejection. To our knowledge, this is the youngest preterm set of craniopagus parasiticus separated in an emergency fashion with good functional and esthetic outcome. CONCLUSIONS Craniopagus parasiticus is an infrequent subvariant of this rare form of twin conjointment which may require urgent separation due to the associated malformations of the parasitic twin; therefore, the fact that both siblings are genetically identical may prove as an advantage to use duramater, bone, and soft tissues from the parasitic twin as ideal grafts for covering the resultant defect after the separation has been performed.
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Affiliation(s)
- Adrian Caceres
- Neurosurgery Department, National Children's Hospital of Costa Rica "Dr. Carlos Sáenz Herrera", Paseo Colón y calle 20 sur, San Jose, Costa Rica, 10103.
| | - Juan Luis Segura-Masis
- Neurosurgery Department, National Children's Hospital of Costa Rica "Dr. Carlos Sáenz Herrera", Paseo Colón y calle 20 sur, San Jose, Costa Rica, 10103
| | - Ariadnna Caceres-Alan
- Neurosurgery Department, National Children's Hospital of Costa Rica "Dr. Carlos Sáenz Herrera", Paseo Colón y calle 20 sur, San Jose, Costa Rica, 10103
| | | | - Justiniano Zamora-Chaves
- Neurosurgery Department, National Children's Hospital of Costa Rica "Dr. Carlos Sáenz Herrera", Paseo Colón y calle 20 sur, San Jose, Costa Rica, 10103
| | - Juan Luis Segura-Valverde
- Neurosurgery Department, National Children's Hospital of Costa Rica "Dr. Carlos Sáenz Herrera", Paseo Colón y calle 20 sur, San Jose, Costa Rica, 10103
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Rufai SR, Gore S, Handley SE, Marmoy OR, Ong J, Dunaway DJ, Jeelani NUO. Enhanced neuro-ophthalmologic evaluation to support separation of craniopagus twins. J Surg Case Rep 2021; 2021:rjaa606. [PMID: 33569170 PMCID: PMC7861574 DOI: 10.1093/jscr/rjaa606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
Craniopagus conjoined twins are extraordinarily rare and present unique challenges to the multidisciplinary team. There is a paucity of literature on optimizing neuro-ophthalmologic evaluation in craniopagus twins. Herein, we present our enhanced neuro-ophthalmologic evaluation and management in 17-month-old male craniopagus twins, uniquely using handheld optical coherence tomography (OCT) plus portable slit-lamp biomicroscopy, indirect ophthalmoscopy and modified forced-choice preferential looking assessment. Staged surgical separation was supported by enhanced neuro-ophthalmologic evaluation, detailed radiology, three-dimensional printing and virtual reality simulation. This represents the fourth separation of craniopagus twins by our unit.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Sri Gore
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Sian E Handley
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Oliver R Marmoy
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Juling Ong
- UCL Great Ormond Street Institute of Child Health, London, UK & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK & Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
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8
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Sahu PK, Singh G, Gupta DK, Mahapatra AK, Kale SS. Pre- and Postoperative Rehabilitation of Craniopagus Conjoined Twins: A Case Report. Phys Occup Ther Pediatr 2021; 41:637-654. [PMID: 33745416 DOI: 10.1080/01942638.2021.1899100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Describe the pre-operative and post-operative stages of physical therapy examination, rehabilitation interventions and outcomes in craniopagus conjoined twins (CCT). METHODS 27-months old total vertical types III CCT were admitted for surgical treatment. A structured rehabilitation program (functional mobility, balance training, sensory stimulation, communication, orthotic management, and caregiver education) was delivered post-operatively at different stages of surgery. The total duration of post-separation rehabilitation was 15 months for Twin A and 23 months for Twin B. RESULTS Pre-operative WeeFIM was 67/126 for both the twins. Post-separation, Twin A improved to a state of complete independence in walking, step climbing, and hand function with a discharge WeeFIM score of 84/126. However, Twin B was completely dependent in bed mobility and transfer activities during discharge (WeeFIM-18/126). Minimal change in functional status was noted in Twin B (discharge FSS score-19/30). Both the twins were transferred to a regional hospital for long-term care. At 67 months of age, Twin B lost his life due to chest infection. CONCLUSIONS Vestibular based therapies, balance, and postural control may be prioritized in the rehabilitation process of CCT. Greater communication and coordination among physical, occupational therapists and other rehabilitation professionals are recommended for successful outcome in these unique cases.
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Affiliation(s)
- Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Singh
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Wemhoff MP, Swong K, Li D, Mugve N, Gramlich LA, Nockels RP. Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins. J Neurosurg Spine 2020; 33:751-756. [PMID: 32858518 DOI: 10.3171/2020.5.spine20537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1-2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.
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Affiliation(s)
| | | | - Daphne Li
- Departments of1Neurological Surgery and
| | - Neal Mugve
- 2Anesthesia, Loyola University Medical Center, Maywood, Illinois
| | - Lisa A Gramlich
- 2Anesthesia, Loyola University Medical Center, Maywood, Illinois
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10
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Eley KA, Rossi-Espagnet MC, Schievano S, Napolitano A, Ong J, Secinaro A, Borro L, Dunaway D, Marras CE, Rennie A, Robertson F, Picardo S, Longo D, Inserra A, Rollo M, Cooper J, Mankad K, Jeelani NO, D'Arco F. Multiparametric Imaging for Presurgical Planning of Craniopagus Twins: The Experience of Two Tertiary Pediatric Hospitals with Six Sets of Twins. Radiology 2020; 298:18-27. [PMID: 33141005 DOI: 10.1148/radiol.2020202216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conjoined twins are rare and pose a challenge to radiologists and surgeons. Craniopagus twins, where conjunction involves the cranium, are especially rare. Even in large pediatric centers, radiologists are unlikely to encounter more than one such event in their medical careers. This rarity makes it daunting to select a CT and MRI protocol for these infants. Using the experience of two tertiary pediatric hospitals with six sets of craniopagus twins, this multidisciplinary and multimodal integrated imaging approach highlights the key questions that need addressing in the decision-making process for possible surgical intervention.
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Affiliation(s)
- Karen A Eley
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Maria Camilla Rossi-Espagnet
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Silvia Schievano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Antonio Napolitano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Juling Ong
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Aurelio Secinaro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Luca Borro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - David Dunaway
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Carlo Efisio Marras
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Adam Rennie
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Fergus Robertson
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Sergio Picardo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Daniela Longo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Alessandro Inserra
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Massimo Rollo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Jessica Cooper
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Kshitij Mankad
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Noor-Owase Jeelani
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Felice D'Arco
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
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11
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Lehrich BM, Brown NJ, Shahrestani S, Sahyouni R, Hsu FPK. James T. Goodrich, MD, PhD, 1946-2020: a historical perspective and his contributions to craniopagus separation. J Neurosurg Pediatr 2020; 26:454-460. [PMID: 32559740 DOI: 10.3171/2020.5.peds20371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
Dr. James Tait Goodrich was an internationally renowned pediatric neurosurgeon who pioneered the neurosurgical procedures for the multistage separation of craniopagus twins. As of March 2020, 59 craniopagus separations had been performed in the world, with Goodrich having performed 7 of these operations. He was the single most experienced surgeon in the field on this complex craniofacial disorder. Goodrich was a humble individual who rapidly rose through the ranks of academic neurosurgery, eventually serving as Director of the Division of Pediatric Neurosurgery at the Children's Hospital at Montefiore Medical Center in the Bronx, New York. In this historical vignette, the authors provide context into the history of and sociocultural attitudes toward conjoined twins; the epidemiology and classification of craniopagus twins; the beginnings of surgery in craniopagus twins; Goodrich's neurosurgical contributions toward advancing treatment for this complex craniofacial anomaly; and vignettes of Goodrich's unique clinical cases that made mainstream news coverage.
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Affiliation(s)
- Brandon M Lehrich
- 1Department of Biomedical Engineering, University of California, Irvine
| | - Nolan J Brown
- 2School of Medicine, University of California, Irvine
| | - Shane Shahrestani
- 3Keck School of Medicine of University of Southern California, Los Angeles
| | - Ronald Sahyouni
- 2School of Medicine, University of California, Irvine
- 4Medical Scientist Training Program, University of California, Irvine; and
| | - Frank P K Hsu
- 5Department of Neurosurgery, UCI Health, School of Medicine, Irvine, California
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12
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Tomasi SO, Winkler PA. Letter: "The Most Interesting Man in the World" - A Tribute to Dr James Tait Goodrich. Neurosurgery 2020; 87:E241-E242. [PMID: 32379318 DOI: 10.1093/neuros/nyaa195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Ottavio Tomasi
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy Christian Doppler Klinik Salzburg, Austria
| | - Peter A Winkler
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy Christian Doppler Klinik Salzburg, Austria
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13
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Transcatheter balloon atrial septostomy in thoraco-omphalopagus conjoined twins. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:209-212. [PMID: 32636909 PMCID: PMC7333194 DOI: 10.5114/aic.2020.96067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 11/17/2022] Open
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14
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Pataki G, Hudák I, Valálik I, Czeibert K, Csapody M, Jósvai A, Fekete A, Kalam A, Imam H, Hasan M, Salek AA, Islam S, Csókay A. Successful multistaged operative separation of 3-year-old craniopagus twins in a multidisciplinary, international collaboration. Surgery 2020; 168:226-230. [PMID: 32507299 DOI: 10.1016/j.surg.2020.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Gergely Pataki
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Pediatric Surgery and Traumatology, St. John's Hospital and North Buda Unified Hospitals, Budapest, Hungary.
| | - István Hudák
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Neurosurgery, Military Hospital-State Health Center, Budapest, Hungary
| | - István Valálik
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Pediatric Surgery and Traumatology, St. John's Hospital and North Buda Unified Hospitals, Budapest, Hungary
| | - Kálmán Czeibert
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Ethology, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Marcell Csapody
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Anesthesiology and Intensive Therapy, Peterfy Sandor Hospital-Clinic and Manninger Jeno National Institute for Traumatology, Budapest, Hungary
| | - Attila Jósvai
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Neurosurgery, Military Hospital-State Health Center, Budapest, Hungary
| | - Attila Fekete
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Plastic Surgery, Military Hospital-State Health Center, Budapest, Hungary
| | - Abul Kalam
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Hossain Imam
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Masroor Hasan
- Department of Burns and Plastic Surgery, Combined Military Hospital, Dhaka, Bangladesh
| | - Al Amin Salek
- Department of Neurosurgery, Combined Military Hospital, Dhaka, Bangladesh
| | - Shafiqul Islam
- Department of Neurosurgery, Dhaka Medical College, Dhaka, Bangladesh
| | - András Csókay
- Action for Defenceless People Foundation, Budapest, Hungary; Department of Neurosurgery, Military Hospital-State Health Center, Budapest, Hungary
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15
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Goldman-Yassen AE, Goodrich JT, Miller TS, Farinhas JM. Preoperative Evaluation of Craniopagus Twins: Anatomy, Imaging Techniques, and Surgical Management. AJNR Am J Neuroradiol 2020; 41:951-959. [PMID: 32439641 DOI: 10.3174/ajnr.a6571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/10/2020] [Indexed: 11/07/2022]
Abstract
Craniopagus twins are a rare congenital malformation in which twins are conjoined at the head. Although there is high prenatal and postnatal mortality for craniopagus twins, successful separation has become more common due to advances in neuroimaging, neuroanesthesia, and neurosurgical techniques. Joined brain tissue, shared arteries and veins, and defects in the skull and dura make surgery technically challenging, and neuroimaging plays an important role in preoperative planning. Drawing on our experience from consultation for multiple successful separations of craniopagus twins, we discuss what radiologists need to know about the anatomy, classification, imaging techniques, and surgical management of craniopagus twins.
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Affiliation(s)
- A E Goldman-Yassen
- From the Department of Radiology (A.E.G.-Y.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Departments of Radiology (A.E.G.-Y., J.M.F.)
| | - J T Goodrich
- Neurosurgery (J.T.G.), Montefiore Medical Center, Bronx, New York
| | - T S Miller
- Department of Radiology (T.S.M.), Stamford Hospital, Stamford, Connecticut
| | - J M Farinhas
- Departments of Radiology (A.E.G.-Y., J.M.F.).,Department of Radiology (J.M.F.), Moffitt Cancer Center Tampa, Florida
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16
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Boer LL, Schepens-Franke AN, Oostra RJ. Two is a Crowd: Two is a Crowd: On the Enigmatic Etiopathogenesis of Conjoined Twinning. Clin Anat 2019; 32:722-741. [PMID: 31001856 PMCID: PMC6849862 DOI: 10.1002/ca.23387] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/31/2022]
Abstract
In this article, we provide a comprehensive overview of multiple facets in the puzzling genesis of symmetrical conjoined twins. The etiopathogenesis of conjoined twins remains matter for ongoing debate and is currently cited-in virtually every paper on conjoined twins-as partial fission or secondary fusion. Both theories could potentially be extrapolated from embryological adjustments exclusively seen in conjoined twins. Adoption of these, seemingly factual, theoretical proposals has (unconsciously) resulted in crystallized patterns of verbal and graphic representations concerning the enigmatic genesis of conjoined twins. Critical evaluation on their plausibility and solidity remains however largely absent. As it appears, both the fission and fusion theories cannot be applied to the full range of conjunction possibilities and thus remain matter for persistent inconclusiveness. We propose that initial duplication of axially located morphogenetic potent primordia could be the initiating factor in the genesis of ventrally, laterally, and caudally conjoined twins. The mutual position of two primordia results in neo-axial orientation and/or interaction aplasia. Both these embryological adjustments result in conjunction patterns that may seemingly appear as being caused by fission or fusion. However, as we will substantiate, neither fission nor fusion are the cause of most conjoined twinning types; rather what is interpreted as fission or fusion is actually the result of the twinning process itself. Furthermore, we will discuss the currently held views on the origin of conjoined twins and its commonly assumed etiological correlation with monozygotic twinning. Finally, considerations are presented which indicate that the dorsal conjunction group is etiologically and pathogenetically different from other symmetric conjoined twins. This leads us to propose that dorsally united twins could actually be caused by secondary fusion of two initially separate monozygotic twins. An additional reason for the ongoing etiopathogenetic debate on the genesis of conjoined twins is because different types of conjoined twins are classically placed in one overarching receptacle, which has hindered the quest for answers. Clin. Anat. 32:722-741, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucas L Boer
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelieke N Schepens-Franke
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelof Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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17
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Heuer GG, Madsen PJ, Flanders TM, Kennedy BC, Storm PB, Taylor JA. Separation of Craniopagus Twins by a Multidisciplinary Team. N Engl J Med 2019; 380:358-364. [PMID: 30673542 DOI: 10.1056/nejmoa1805132] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Conjoined twins who are classified as craniopagus (joined at the cranium) have a rare congenital anomaly. Despite advances in surgical techniques and critical care, the rate of complications and death is still high among twins with total fusion in which the superior sagittal sinus is shared. Here, we describe total-fusion craniopagus twins who at 10 months of age underwent successful surgical separation performed by a multidisciplinary team. Computer-aided design and modeling with a three-dimensional printer, custom-designed cranial distraction and constriction devices, and intraoperative navigation techniques were used. These techniques allowed for separation of the twins at an early age and harnessed the regenerative capacity of their young brains.
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Affiliation(s)
- Gregory G Heuer
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
| | - Peter J Madsen
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
| | - Tracy M Flanders
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
| | - Benjamin C Kennedy
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
| | - Phillip B Storm
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
| | - Jesse A Taylor
- From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia
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Nejat F, Habibi Z, Goudarzi M, Azad MS, Moradi E, Heidari V, Kadivar M, Soltani ZE, Kouchakzadeh L. Emergency separation of craniopagus twins: case report. J Neurosurg Pediatr 2017; 20:307-313. [PMID: 28708016 DOI: 10.3171/2017.1.peds16306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Craniopagus is a very rare congenital anomaly that tends to affect females more often than males. It is classified as partial or total. Most affected twins are either stillborn or die during the perinatal period. Those who survive birth should undergo detailed radiological evaluations soon after their condition becomes stable so that the precise anatomy of the conjoined part can be defined and surgery can be planned in detail by a multidisciplinary team. Recommendations for decreasing the risk of unsuccessful surgery include performing surgery on an elective basis after extensive preoperative radiological evaluations as well as when the twins are at an acceptable age and weight for a complex surgical separation, generally as staged procedures. In addition, the operation should be performed by a well-equipped expert multidisciplinary team. When one of the conjoined twins dies, however, surgical separation cannot be postponed because the shared circulatory system predisposes the alive child to life-threatening complications, including coagulopathy. The authors report on the successful separation of craniopagus twins performed on an emergency basis at 32 weeks of gestational age because of the sudden death of one of them. At the time of separation surgery, the twins each weighed 1250 g. To the best of the authors' knowledge, this is the youngest age and lowest weight yet reported for successful surgical separation. The surviving twin developed a pseudomeningocele, which required a second operation and placement of a cystoperitoneal shunt 4 months after the operation. Additional surgery is planned to repair a cranial defect that resulted from the pseudomeningocele, but his general physical and mental condition was otherwise good at latest follow-up (12 months after separation surgery).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Leila Kouchakzadeh
- Pediatrics, Children's Medical Center, Tehran University of Medical Science; and
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19
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Sousa AMM, Meyer KA, Santpere G, Gulden FO, Sestan N. Evolution of the Human Nervous System Function, Structure, and Development. Cell 2017; 170:226-247. [PMID: 28708995 DOI: 10.1016/j.cell.2017.06.036] [Citation(s) in RCA: 244] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 04/21/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
The nervous system-in particular, the brain and its cognitive abilities-is among humans' most distinctive and impressive attributes. How the nervous system has changed in the human lineage and how it differs from that of closely related primates is not well understood. Here, we consider recent comparative analyses of extant species that are uncovering new evidence for evolutionary changes in the size and the number of neurons in the human nervous system, as well as the cellular and molecular reorganization of its neural circuits. We also discuss the developmental mechanisms and underlying genetic and molecular changes that generate these structural and functional differences. As relevant new information and tools materialize at an unprecedented pace, the field is now ripe for systematic and functionally relevant studies of the development and evolution of human nervous system specializations.
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Affiliation(s)
- André M M Sousa
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Kyle A Meyer
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Gabriel Santpere
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Forrest O Gulden
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Nenad Sestan
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA; Department of Genetics, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Section of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA; Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA; Kavli Institute for Neuroscience, Yale School of Medicine, New Haven, CT, USA.
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20
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Mian A, Gabra NI, Sharma T, Topale N, Gielecki J, Tubbs RS, Loukas M. Conjoined twins: From conception to separation, a review. Clin Anat 2017; 30:385-396. [PMID: 28195364 DOI: 10.1002/ca.22839] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/27/2022]
Abstract
Conjoined twins are suggested to result from aberrant embryogenesis. The two main theories proposed to explain the phenomena are fission and fusion. The incidence rate is 1 in 50,000 births; however, since about 60% of the cases are stillborn, the true incidence is approximated at 1 in 200,000. There is a higher predisposition towards female than male gender with a ratio of 3:1. Conjoined twins are classified based upon the site of attachment. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Meticulous preoperative evaluation, planning, and preparedness of the team are crucial for a successful separation. Separation of conjoined twins poses several technical, legal, and ethical issues. Clin. Anat. 30:385-396, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Asma Mian
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Nader Ishak Gabra
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Tanuj Sharma
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Nitsa Topale
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Jerzy Gielecki
- Department of Anatomy, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland
| | | | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
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21
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Abstract
Separation of craniopagus twins is fraught by ethical issues. The surgery is high risk and may involve the sacrifice of one twin. We review surgical successes in separation of craniopagus twins and consider ethical and legal concepts affecting the decision to undertake such procedures. Our discussion considers how Gillett's potentiality principle and the concept of moral permissibility may be used to arrive at fair and realistic decisions.
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Vagyannavar R, Bhattacharyya A, Misra G, Hashim M, Asmita. Craniopagus twins for magnetic resonance imaging. Saudi J Anaesth 2017; 11:509-510. [PMID: 29033747 PMCID: PMC5637443 DOI: 10.4103/sja.sja_89_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Raghavendra Vagyannavar
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Amrita Bhattacharyya
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Gaurav Misra
- Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Mohammad Hashim
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Asmita
- Department of Senior Resident, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
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Herkiloğlu D, Baksu B, Pekin O. Early prenatal diagnosis of thoraco-omphalopagus twins at ten weeks of gestation by ultrasound. Turk J Obstet Gynecol 2016; 13:106-108. [PMID: 28913103 PMCID: PMC5558337 DOI: 10.4274/tjod.89814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/03/2016] [Indexed: 12/01/2022] Open
Abstract
Early prenatal diagnosis of conjoined twins, an extreme form of monozygotic twinning, is very important for the further management and counselling of parents because they are associated with high perinatal mortality. We present a case of thoraco-omphalopagus twins diagnosed at ten weeks and four days of gestation by two-dimensional Doppler ultrasound, which was then terminated.
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Affiliation(s)
- Dilşat Herkiloğlu
- Zeynep Kamil Women's and Children's Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Başak Baksu
- Zeynep Kamil Women's and Children's Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Oya Pekin
- Zeynep Kamil Women's and Children's Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
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25
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Bosmia AN, Smelser LB, Griessenauer CJ. An apocryphal case of craniopagus parasiticus: the legend of Edward Mordake. Childs Nerv Syst 2015; 31:2211-2. [PMID: 25378260 DOI: 10.1007/s00381-014-2581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Anand N Bosmia
- UAB School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL, 35233, USA.
| | - Luke B Smelser
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Abstract
Craniopagus twins are rare and account for up to 6% of all conjoined twins. No hospital will encounter many such twins and the opportunity to develop expertise is limited. We have dealt with 2 such sets and illustrate our approach by reference to our most recent set. We believe that detailed imaging allows precise delineation of the anatomy and facilitates detailed planning of the surgery. When venous drainage from the 2 brains is connected, we believe that staged separation is preferable as gradual alteration of hemodynamics may be safer than a single-stage procedure.
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Affiliation(s)
- David Dunaway
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK.
| | - N U Owase Jeelani
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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27
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Abstract
Imaging plays a key role in the management of conjoined twins. Pre-operative multi-modality studies are vital to assess operability and to aid surgical planning. Technical advances in imaging such as high-resolution isovolumetric magnetic resonance imaging (MRI) techniques and three-dimensional modeling now result in extremely accurate anatomical information. Varied information from a comprehensive radiological work-up enables the surgeons to plan the safest possible operative procedure, helps the anesthetic team before and during surgery, and guides the intensive care team in the post-operative phase. This article will review the radiological techniques used in our institution, highlighting potential pitfalls with the various imaging modalities.
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Affiliation(s)
- Sarah G Watson
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
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Alokaili RN, Ahmed ME, Al Feryan A, Goodrich JT, Aloraidi A. Neurointerventional participation in craniopagus separation. Interv Neuroradiol 2015; 21:552-7. [PMID: 26063696 DOI: 10.1177/1591019915590313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Craniopagus-type conjoined twins (joined at the head) are exceedingly rare. Separation of craniopagus conjoined twins is a challenging task mainly owing to complex vascular anatomy and limited experience with this disorder. Modern neuroimaging techniques including digital subtraction angiography can be used to preoperatively assess the cerebral vascular system. These techniques can also provide the raw data to fabricate three-dimensional true-scale models. We report a case in which endovascular techniques have been used in the separation of craniopagus conjoined twins. To our knowledge there are no reports of successful incorporation of neurointerventional methods in the disconnection of shared venous channels.
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Affiliation(s)
| | | | - Ahmed Al Feryan
- King Abdulaziz Medical City for National Guards, Riyadh, Saudi Arabia
| | - James T Goodrich
- King Abdulaziz Medical City for National Guards, Riyadh, Saudi Arabia
| | - Ahmed Aloraidi
- King Abdulaziz Medical City for National Guards, Riyadh, Saudi Arabia
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Alkhateeb M, Mashaqbeh M, Magableh S, Hadad R, Nseer Q, Alshboul A. Early prenatal diagnosis of thoracopagus twins by ultrasound. Acta Inform Med 2015; 23:60-2. [PMID: 25870495 PMCID: PMC4384844 DOI: 10.5455/aim.2015.23.60-62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/12/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction: Conjoined twins are identical twins joined in utero. It’s a rare phenomenon and present a unique challenge to obstetricians and pediatric surgeons. Conjoined twins are complex complication of monozygotic twinning, which is associated with high perinatal mortality. Case report: At our clinic complete anomaly scan was done, the patients was found to have monozygotic twins of 15 weeks gestation and carrying a conjoint twin. Our ultrasound revealed fully developed heads facing each other, joint at the thorax and sharing a common abdomen. These twins share a single heart with two atrium and two ventricle. They decide for termination of pregnancy after taken the opinion of religious people. Termination of pregnancy was performed by many methods and we chose to use cytotec tablets which inserted vaginally and the outcome was conjoint twin with two bodies fused from the upper thorax to lower belly. Both fetuses are female and died immediately after termination of pregnancy.
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Affiliation(s)
- Mahmoud Alkhateeb
- Department of Obstetrics and Gynecology, Feto-Maternal unit. Royal Medical Services, Irbid, Jordan
| | - Mahmoud Mashaqbeh
- Department of Obstetrics and Gynecology, Feto-Maternal unit. Royal Medical Services, Irbid, Jordan
| | - Sami Magableh
- Department of Pediatrics. Royal Medical Services, Irbid, Jordan
| | - Rafiq Hadad
- Department of Radiology. Royal Medical Services, Irbid, Jordan
| | - Quteiba Nseer
- Department of Medicine. Royal Medical Services, Irbid, Jordan
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Abstract
We present a case of female cephalothoracoomphalopagus conjoind twin, which is extremely rare type of conjoined twins. We also review the contemprory knowledge regarding incidence, etiopathogenesis, antenatal diagnosis and outcone or the prognosis of conjoint twins. The case belong to hindu female, no history of consanguineous marriage, ingestion of drugs or exposure to any radiation. History of one abortion and one twin delivery present. Conjoind twin was cephalothoracoomphalopagus type, delivered vaginaly at 30 wks of gestion to a 25 yrs old multigravida. Management of conjoind twin still remain challenges because of multiple congenital anomalies and poor outcome is seen.
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Affiliation(s)
- Sunita Koreti
- Department of Pediatrics, G. R. Medical College, Gwalior, Madhya Pradesh, India
| | | | - G Singh Patell
- Department of Pediatrics, G. R. Medical College, Gwalior, Madhya Pradesh, India
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31
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Sanhal CY, Ozekinci M, Mendilcioglu I, Sakinci M, Simsek M. Prenatal diagnosis of total type 1 vertical craniopagus with 3-dimensional sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:179-181. [PMID: 24371115 DOI: 10.7863/ultra.33.1.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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32
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Kho Uy E, Speranza M, Wong CS. Staged Separation of Craniopagus Conjoined Twins: A Multidisciplinary Approach. AORN J 2012; 96:125-51. [DOI: 10.1016/j.aorn.2012.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/04/2011] [Accepted: 05/30/2012] [Indexed: 12/01/2022]
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Sciubba DM, Gokaslan ZL, Black JH, Simmons O, Suk I, Witham TF, Bydon A, Wolinsky JP. 5-Level spondylectomy for en bloc resection of thoracic chordoma: case report. Neurosurgery 2012; 69:onsE248-55; discussion onsE255-6. [PMID: 21937945 DOI: 10.1227/neu.0b013e31822e81c0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Primary tumors of the spine are considered for en bloc resection to improve local control and even obtain cure. Anatomic restrictions often prohibit extensive resections with negative margins that are safe and feasible. We report the first case involving a patient with a large chordoma of the thoracic spine who underwent a successful 5-level spondylectomy with bilateral chest wall resection for en bloc resection without neurologic compromise. CLINICAL PRESENTATION A 26-year-old woman with a chest mass was found to have a T1-5 chordoma via a percutaneous biopsy. En bloc resection of the mass was thought to be the best option for long-term local control and possible cure. She presented without neurologic or pulmonary dysfunction. The patient underwent a 3-stage procedure. The first stage involved a posterior C2-T8 exposure, allowing release of posterior elements from C7 to T6 and instrumented stabilization from C2 to T8. T1-5 ribs were cut bilaterally, and 2 wire saws were placed ventral to the thecal sac at the C7-T1 and T5-6 disc levels. The second stage involved a right-sided thoracotomy, and the T5-6 wire saw was used to complete the lower osteotomy. The third stage involved completion of the C7-T1 osteotomy with the wire saw, delivery of the tumor specimen en bloc, ventral reconstruction of the spine with a titanium mesh cage, and bilateral thoracoplasty. CONCLUSION This is the first case report of a 5-level spondylectomy for en bloc resection of an extensive thoracic chordoma via a bilateral thoractomy without neurologic compromise.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Díaz RR, Lancheros JLA, Hoyos VC. Manejo anestésico y hallazgos radiológicos en siameses craneópagos durante resonancia magnética. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2011. [DOI: 10.5554/rca.v39i4.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cranial conjoined twins: surgical and anesthetic challenges for a routine procedure: adenoidectomy and examination of ears. Int J Pediatr Otorhinolaryngol 2011; 75:444-7. [PMID: 21288577 DOI: 10.1016/j.ijporl.2010.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/16/2010] [Accepted: 12/17/2010] [Indexed: 11/20/2022]
Abstract
Craniopagus conjoined twins have long been the subject of interest because of the rarity and peculiarity of their juxtaposition. We present the surgical, airway and anesthetic challenges in craniopagus conjoined twins, in which one of the twins underwent adenoidectomy for obstructive sleep breathing disorder. The surgical procedure required a special setting from an anesthetic perspective whereby both children needed anesthesia due to the complex physiology of their brains and cardiovascular systems. As well, we took the opportunity to do bilateral ear examinations of both twins.
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36
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Osmanağaoğlu MA, Aran T, Güven S, Kart C, Ozdemir O, Bozkaya H. Thoracopagus conjoined twins: a case report. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:238360. [PMID: 21660094 PMCID: PMC3099464 DOI: 10.5402/2011/238360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/03/2010] [Indexed: 12/05/2022]
Abstract
Objective. Conjoined twin is a rarely seen congenital anomaly together with severe mortality and morbidity. The more common types of conjoined twins include the thoracopagus type, where the fusion is anterior, at the chest, and involves the heart. We are reporting one case of conjoined thoracopagus twins diagnosed by ultrasonography at 11 weeks. Case Report. In a multigravid pregnant woman who has been admitted to our clinic with a diagnosis of conjoined twins, thoracopagus, by ultrasonography at an 11-week gestation, termination of the pregnancy was performed. Conclusion. Making an early diagnosis with ultrasonographic examination gives the parents a chance to elect pregnancy termination.
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Affiliation(s)
- Mehmet A Osmanağaoğlu
- Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon 61080, Turkey
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Ultrasound diagnosis of cephalopagus conjoined twin pregnancy at 29 weeks. Biomed Imaging Interv J 2010; 6:e38. [PMID: 21611074 PMCID: PMC3097803 DOI: 10.2349/biij.6.4.e38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/01/2010] [Accepted: 09/04/2010] [Indexed: 12/26/2022] Open
Abstract
The authors report a case of a cephalopagus conjoined twin that was diagnosed at 29 weeks of gestation despite the mother having had two ultrasounds done previously. The fetus had one head and face, fused thoraces, common umbilicus but had two pelvises and two sets of genitalia. The fetus had four normally formed legs and arms. Antenatal ultrasound images are supplemented by post natal photographs. A review of literature, clues to ultrasound diagnosis and possible causes of missing this significant abnormality until the 3rd trimester are discussed.
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Parameswari A, Vakamudi M, Raghupathy V, Siddhartha R. Anaesthetic management of total craniopagus twins for magnetic resonance imaging and cerebral angiography. Br J Anaesth 2010; 105:368-70. [PMID: 20595197 DOI: 10.1093/bja/aeq165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe the anaesthetic management of 4-yr-old total craniopagus twins for radiological investigations. There are some unique anaesthetic problems associated with this condition. These include cross-circulation between the twins that results in induction of both the twins after the administration of i.v. induction agent to one twin and difficulty in mask ventilating both the twins simultaneously due to the angle between the heads; different arterial pressures in the two children complicate pharmacological management and underline the importance of physiological measures to control arterial pressure. Adequate preparation and teamwork is the keystone to the management of these patients.
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Affiliation(s)
- A Parameswari
- Department of Anesthesiology, Critical Care and Pain Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, No.1, Ramachandra Nagar, Porur, Chennai 600 116, Tamil Nadu, India.
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39
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40
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Abstract
Craniopagus twins represent a rare phenomenon of congenital misfortune. Modern neurosurgical techniques have created opportunities for successful separation and the promise of a normal existence for these children, who in the past were often left as historical footnotes or put on display as oddities of nature. The authors document a brief history of conjoined twinning and discuss the modern science of craniopagus epidemiology, classification, and separation. In particular, the strategies used and the rationale for staged surgical separation are highlighted.
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Affiliation(s)
- Samuel R Browd
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Medical Center, University of Utah Health Sciences Center, Salt Lake City, Utah 84113, USA
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