A rare case of craniopagus parasiticus delivered vaginally at a district hospital

Craniopagus Parasiticus is a very rare type of parasitic twinning. It has an incidence of only 4-6/10,00,000 births. Most of the babies with Craniopagus Parasiticus are still born with only few cases which survived after postpartum surgical separation. In Craniopagus Parasiticus the head of one of the twins is parasitic and protrudes from the head of the normal twin with an undeveloped or underdeveloped body. The skulls of the twins are fused but the body of one of the twins is not developed. The developed twin is known as the auto site while the undeveloped twin is the parasite. Age of the mother or certain nutritional factors have been implicated in the etiology of this type of twinning. This is a rare case report of a female baby with a parasitic craniopagus delivered vaginally at this district hospital. The patient was a fourth gravida 28 year old. There was antenatal polyhydramnios. The patient delivered preterm a still born female baby with a parasitic co-twin. In this case the heads of the twins were fused in temporal and parietal areas while the body of the parasitic twin was completely undeveloped. It was a morphologically female baby with rudimentary labia. The causes of Craniopagus Parasiticus are still not known. Scientists and researchers are continuing work to determine these and also to improve the prognosis and chances of post-surgical survival of these twins. Till present day however there have been only limited number of studies on Craniopagus Parasiticus owing to the rarity of the cases.

Manejo anestésico y hallazgos radiológicos en siameses craneópagos durante resonancia magnética / Anesthetic management and radiological findings in craniopagus conjoined twins on nuclear magnetic resonante

Los siameses tienen una prevalencia demasiado baja, pero cuando se presenta un caso, es importante contar con un grupo humano multidisciplinario, conformado por anestesiólogo, radiólogo, pediatra y especialistas de las áreas quirúrgicas según el tipo de siameses. Así mismo, es fundamental estudiar todas las implicaciones fisiológicas, farmacodinámicas y anatómicas del caso; entre ellas, la circulación cruzada. Todo esto, con el fin de procurar una planificación adecuada que permita el mejor resultado posible. El presente es un reporte de caso de siamesas craneópagas de 3 días de vida programadas para resonancia magnética.

The prevalence of conjoined twins is extremely low, but whenever a case occurs, it is of the utmost importance to have a multidisciplinary team consisting of an anesthesiologist, a radiologist, a pediatrician, and specialists in various surgical areas, depending on the type of conjoined twins. Likewise, it is critical to consider all the physiological, pharmacodynamic and anatomical implications, including cross circulation. The goal is to plan appropriately in order to enable the best possible result. This report is intended to present a case of 3 day-old craniopagus conjoined female twins scheduled for nuclear magnetic resonance (MRI).

Microsurgical separation of the protruded cerebral tissue in the case of complex craniopagus twins using the neuronavigation system / 中华显微外科杂志

Objective To report the microsurgical separation of the protruded cerebral tissue in the case of complex craniopagus twins and evaluate the role of the neuronavigation system in this operation Methods After the multiple bone flap were made,register again and then separate the cerebral tissue along the arachnoid plane under the guiding of the neuronavigation system(SNN) until the straight sinus was exposed Results The protruded cerebral hemisphere and cerebellar hemisphere of the twins were successfully separated Unfortunately,part of the occipital lobe of twin B(right) had to be removed because of the brain swelling Conclusion In the case of complicated craniopagus,the neuronavigation system is valuable in positioning the deep common sinus To separate the cerebral tissue along the arachnoid plane under surgical microscope can reduce the cerebral injury

Separation and reconstruction of the shared venous sinuses of craniopagus twins / 中华显微外科杂志

Objective To explore the importance of the separation and reconstruction of the shared venous sinuses of a craniopagus twins Methods The shared superior sagittal sinus, confluence of sinuses, transverse sinus and straight sinus were separated using microsurgical techniques Meantime, one bypass was established from the superior sagittal sinus and the straight sinus to the internal jugular vein with help of the bypass shunt in twin B (right) The above mentioned sinuses were reconstructed with the artificial vessels The normal superior sagittal sinus and confluence of sinuses were preserved in the twin A (left) Results Twin A recovered with no nervous deficits Unfortunately, twin B died of renal failure and hyperkalemia 22 hours after the operation Conclusion The shunt and reconstruction of the venous sinus are the key techniques for the success of separation of craniopagus twins using the microsurgical techniques

Primarily reconstruction for the scalp,skull and dura defects of type D craniopagus / 中华显微外科杂志

Objective To discuss the methods of primarily repairing scalp,skull and dura defects of separated type D craniopagus Methods The huge defects in craniopagus was primarily repaired by the application of scalp expander, transferring scalp flap, repairing dura with pedicle periosteums, repairing skull defects with Titanium plates Results The survival baby has a good sharp of skull and well healing of scalp postoperatively Conclusions Defects of separated type D craniopagus can be primarily repaired

Repair of large area skull soft tissue defects in the case of complex craniopagus twins / 中华显微外科杂志

Objective To explore the experience in scalp operation of craniopagus and repairing of scalp and dura defect after separating Methods Analysis the cause and management of the complication after skin expander implantation Discuss the characteristic of repairing skull soft tissue defect by expanded scalp flap and fiber capsule Results Dural and scalp defect could be repaired satisfactory with expanded scalp at one stage Conclusion It's necessary and important for successful separation in D type craniopagus with preoperation care, an elabarate operative management, careful postoperative observation and timely treatment for complication

Effect of digital subtract cerebral angiography on microsurgical separation of craniopagus / 中华显微外科杂志

Objective To investigate the effect of cerebral angiography on separation of craniopagus during the period of preoperation and microsurgical operation Methods There was a case of craniopagus being separated in our hospital recently Cerebral arteriography at 3 months of life, arteriography and venography through femoral vessels at 16 months were performed to analyze the twin vascular circulations of bilateral internal carotid artery, external carotid artery, vertebral artery, and venous sinus Intraoperative cerebral angiography helps to evaluate the cerebral circulations Results Preoperative cerebral angiography showed no intracranial arterial connection in the pontes of craniopagus The posterior 1/3 part of superior sagittal sinus, partial transverse sinus and torcular herophili were confluented in two children Cerebral angiography during operation was significant for monitoring the management of the part of confluent venous sinus Conclusion Cerebral angiography is the best method to investigate the vascular conditions of craniopagus The selective sinus angiography is very important in analyzing the abnormal anatomy and hemodynamics of venous sinus in the pontes Intraoperative angiography can direct the bypass shunt and reconstruction of the sinus

Application of spiral computerized tomographic angiography in microsurgery of separating craniopagus twins / 中华显微外科杂志

Objective To evaluate the role of 3 D spiral computerized tomographic angiography (SCTA) in microsurgery of separating craniopagus twins Methods A case of craniopagus twins underwent spiral CTA Image reconstruction was made by shaded surface display Result SCTA demonstrated osseous fusion in twins skull Parts of bone and dura mater were found to be absent in the fused area Two parts of brain tissues were linked together, and some area were fused Twins' one third of posterior superior sagittal sinuses were fused and converged into a common sinus One side of their transverse sinuses were fused Conclusion SCTA can clearlly reveal the abnormalities of skull, cerebrum, intracranial blood vessels, especially the stereostruction between intracranial blood vessels and skull SCTA is useful for intraoperative bone design and decision of surgical route and has important value in formulating surgical plans

A Case of Craniopagus Twins

The craniopagus twins to be described were admitted to SNUH on 20 Nov, 1981. Their mother was a healthy woman of 32 and Caesarean Section was performed at the 38th week at a local clinic. Their combined weight was 4.75kg and their subsequent progress was satisfactory. They were grown at the nursery of SNUH. Twin B had anemia and congestive heart failure. On the 181th day of life, twin B developed sudden respiratory arrest. About 25 minutes after death of twin B, we performed emergent operation to separate them for survival of twin A. We obtained the interesting findings as followings;A dural shelf was present on one side of junction, a leptomeningeal coverage on the other. Cerebral hemisphere was interdigitated on the side of leptomeningeal coverage. Pons were interconnected by nervous band.