Total vertex craniopagus with crossed venous drainage: Case report of successful surgical separation

Dale M. Swift, Bradley Weprin, Fred Sklar, David Sacco, Kenneth Salyer, David Genecov, Raul Barcello, Mario Ortega, Ken Shapiro

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Case report: Twin boys joined at the head in a total vertex configuration were born in Egypt in June 2001. At 12 months, they were transported to Dallas for evaluation and eventual surgical separation. In Dallas, a large multidisciplinary team of health care providers from two pediatric hospitals was assembled to care for the boys. Extensive radio-graphic evaluation revealed that the twins had essentially separate, well-formed brains, each with regions of schizencephaly. Each child's left cerebral hemisphere drained most of the venous blood to the right jugular system of the other. A detailed assessment of the foreseeable risks of surgical separation was then estimated and presented to the parents, as well as to the ethics committee of the two institutions. The decision was then made to proceed with separation. Surgical planning included the construction of multiple polymer models, and the design and construction of customized head holders and an operating table. Prior to separation a series of preparatory operations were performed to expand the scalp, as well as the fascia lata for dural grafting. At the age of 28 months, the twins were successfully separated during a 33-h operation. No attempt was made to reconstruct the dural venous sinuses. Scalp closure was adequate, requiring a split-thickness skin graft on one boy. Outcome: Postoperatively each child demonstrated an incomplete right hemiparesis. One twin required cerebral spinal fluid shunting. Neither child had a CSF leak or a CSF infection. At 6 months follow-up, both boys are rapidly acquiring speech in both English and Arabic, motor function is improving, and both are progressing toward independent ambulation.

Original languageEnglish (US)
Pages (from-to)607-617
Number of pages11
JournalChild's Nervous System
Volume20
Issue number8-9
DOIs
StatePublished - Aug 2004

Fingerprint

Drainage
Scalp
Head
Operating Tables
Fascia Lata
Ethics Committees
Pediatric Hospitals
Egypt
Cerebrum
Paresis
Radio
Health Personnel
Walking
Polymers
Neck
Parents
Transplants
Skin
Brain
Infection

Keywords

  • Conjoined twins
  • Craniopagus
  • Polymer models

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Total vertex craniopagus with crossed venous drainage : Case report of successful surgical separation. / Swift, Dale M.; Weprin, Bradley; Sklar, Fred; Sacco, David; Salyer, Kenneth; Genecov, David; Barcello, Raul; Ortega, Mario; Shapiro, Ken.

In: Child's Nervous System, Vol. 20, No. 8-9, 08.2004, p. 607-617.

Research output: Contribution to journalArticle

Swift, Dale M. ; Weprin, Bradley ; Sklar, Fred ; Sacco, David ; Salyer, Kenneth ; Genecov, David ; Barcello, Raul ; Ortega, Mario ; Shapiro, Ken. / Total vertex craniopagus with crossed venous drainage : Case report of successful surgical separation. In: Child's Nervous System. 2004 ; Vol. 20, No. 8-9. pp. 607-617.
@article{1e7419bd32fd4bd9ab402fc95db029db,
title = "Total vertex craniopagus with crossed venous drainage: Case report of successful surgical separation",
abstract = "Case report: Twin boys joined at the head in a total vertex configuration were born in Egypt in June 2001. At 12 months, they were transported to Dallas for evaluation and eventual surgical separation. In Dallas, a large multidisciplinary team of health care providers from two pediatric hospitals was assembled to care for the boys. Extensive radio-graphic evaluation revealed that the twins had essentially separate, well-formed brains, each with regions of schizencephaly. Each child's left cerebral hemisphere drained most of the venous blood to the right jugular system of the other. A detailed assessment of the foreseeable risks of surgical separation was then estimated and presented to the parents, as well as to the ethics committee of the two institutions. The decision was then made to proceed with separation. Surgical planning included the construction of multiple polymer models, and the design and construction of customized head holders and an operating table. Prior to separation a series of preparatory operations were performed to expand the scalp, as well as the fascia lata for dural grafting. At the age of 28 months, the twins were successfully separated during a 33-h operation. No attempt was made to reconstruct the dural venous sinuses. Scalp closure was adequate, requiring a split-thickness skin graft on one boy. Outcome: Postoperatively each child demonstrated an incomplete right hemiparesis. One twin required cerebral spinal fluid shunting. Neither child had a CSF leak or a CSF infection. At 6 months follow-up, both boys are rapidly acquiring speech in both English and Arabic, motor function is improving, and both are progressing toward independent ambulation.",
keywords = "Conjoined twins, Craniopagus, Polymer models",
author = "Swift, {Dale M.} and Bradley Weprin and Fred Sklar and David Sacco and Kenneth Salyer and David Genecov and Raul Barcello and Mario Ortega and Ken Shapiro",
year = "2004",
month = "8",
doi = "10.1007/s00381-004-1011-6",
language = "English (US)",
volume = "20",
pages = "607--617",
journal = "Child's Nervous System",
issn = "0256-7040",
publisher = "Springer Verlag",
number = "8-9",

}

TY - JOUR

T1 - Total vertex craniopagus with crossed venous drainage

T2 - Case report of successful surgical separation

AU - Swift, Dale M.

AU - Weprin, Bradley

AU - Sklar, Fred

AU - Sacco, David

AU - Salyer, Kenneth

AU - Genecov, David

AU - Barcello, Raul

AU - Ortega, Mario

AU - Shapiro, Ken

PY - 2004/8

Y1 - 2004/8

N2 - Case report: Twin boys joined at the head in a total vertex configuration were born in Egypt in June 2001. At 12 months, they were transported to Dallas for evaluation and eventual surgical separation. In Dallas, a large multidisciplinary team of health care providers from two pediatric hospitals was assembled to care for the boys. Extensive radio-graphic evaluation revealed that the twins had essentially separate, well-formed brains, each with regions of schizencephaly. Each child's left cerebral hemisphere drained most of the venous blood to the right jugular system of the other. A detailed assessment of the foreseeable risks of surgical separation was then estimated and presented to the parents, as well as to the ethics committee of the two institutions. The decision was then made to proceed with separation. Surgical planning included the construction of multiple polymer models, and the design and construction of customized head holders and an operating table. Prior to separation a series of preparatory operations were performed to expand the scalp, as well as the fascia lata for dural grafting. At the age of 28 months, the twins were successfully separated during a 33-h operation. No attempt was made to reconstruct the dural venous sinuses. Scalp closure was adequate, requiring a split-thickness skin graft on one boy. Outcome: Postoperatively each child demonstrated an incomplete right hemiparesis. One twin required cerebral spinal fluid shunting. Neither child had a CSF leak or a CSF infection. At 6 months follow-up, both boys are rapidly acquiring speech in both English and Arabic, motor function is improving, and both are progressing toward independent ambulation.

AB - Case report: Twin boys joined at the head in a total vertex configuration were born in Egypt in June 2001. At 12 months, they were transported to Dallas for evaluation and eventual surgical separation. In Dallas, a large multidisciplinary team of health care providers from two pediatric hospitals was assembled to care for the boys. Extensive radio-graphic evaluation revealed that the twins had essentially separate, well-formed brains, each with regions of schizencephaly. Each child's left cerebral hemisphere drained most of the venous blood to the right jugular system of the other. A detailed assessment of the foreseeable risks of surgical separation was then estimated and presented to the parents, as well as to the ethics committee of the two institutions. The decision was then made to proceed with separation. Surgical planning included the construction of multiple polymer models, and the design and construction of customized head holders and an operating table. Prior to separation a series of preparatory operations were performed to expand the scalp, as well as the fascia lata for dural grafting. At the age of 28 months, the twins were successfully separated during a 33-h operation. No attempt was made to reconstruct the dural venous sinuses. Scalp closure was adequate, requiring a split-thickness skin graft on one boy. Outcome: Postoperatively each child demonstrated an incomplete right hemiparesis. One twin required cerebral spinal fluid shunting. Neither child had a CSF leak or a CSF infection. At 6 months follow-up, both boys are rapidly acquiring speech in both English and Arabic, motor function is improving, and both are progressing toward independent ambulation.

KW - Conjoined twins

KW - Craniopagus

KW - Polymer models

UR - http://www.scopus.com/inward/record.url?scp=4544283990&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4544283990&partnerID=8YFLogxK

U2 - 10.1007/s00381-004-1011-6

DO - 10.1007/s00381-004-1011-6

M3 - Article

C2 - 15309476

AN - SCOPUS:4544283990

VL - 20

SP - 607

EP - 617

JO - Child's Nervous System

JF - Child's Nervous System

SN - 0256-7040

IS - 8-9

ER -