Separation of craniopagus conjoined twins with a staged approach.

摘要: The separation of craniopagus conjoined twins is a very rare and complex challenge. As with many challenges, it presents initially as deceptively simple problem requiring only the most basic clinical techniques. in reconstructive problems, this paradigm mandates that neurosurgical team performs plastic surgeons providing closure at end separation. Historically, these approaches have included, other types twins, use tissue expansion before followed by surgery. In best hands, capable medical centers, mortality reported literature for past 50 years greater than 50%. Craniofacial surgery frequently demands coordinated effort between neurosurgery specializations; separating takes coordination to stratospheric level. It is, however, paramount importance. Success clearly requires an understanding interrelationship "separation" "reconstruction" decisions made 1 aspect will profound impact on another can be disastrous or, if planned well, advantageous.We were contacted evaluate male infant Radiographic studies suggested brains separate, their they "fit separation." We reviewed our colleagues' experiences similar cases around world. became clear whether had been unsuccessful or successful, variety issues accompanied follows: (1) massive intraoperative hemorrhage, (2) cerebral edema, (3) venous infarcts, (4) swelling flaps, (5) dehiscence repairs cerebrospinal fluid (CSF) leak, meningitis, brain exposure. Although initial plan was separate same fashion previous (ie, single-stage preceded scalp), approach increases pressure during component therefore set up cascade events favoring failure rather success. Wishing favor success, we elected design open-ended multistaged improve collateral circulation. believe would drainage, prevent increased pressure, diminish integrity dura flap repair turn lessen risk CSF leak. stages also allow recover from each stage progressing next while continuing receive nutritional support physical therapy. Four major 9 ½ months led successful There has no leak meningitis. To knowledge, technique since applied 2 sets outcomes.A review pertinent literature, rationale, methodology are discussed article.