DOCSLIB.ORG

Radiologic Investigation of Craniopagus Twins (Partial Type)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Radiologic Investigation of Craniopagus Twins (Partial Type) 206 Radiologic Investigation of Craniopagus Twins (Partial Type) Philip Stanley,' Frank M. Anderson,2 Hervey D. Segall' Conjoined twins are uncommon, occurring in about junction between the occipital region of twin A and the parietal 1 : 50,000 li ve births [1]. The most common form is thora­ region of twin B (fig . 2). It could not be assessed whether there was copagus with the junction in the region of the sternum, and complete bony separation of th e two cranial vaults at the level of th e rarest is craniopagus where the two skulls are joined. the junction because no second projection was taken. The latter occurs once in about 2.5 million births [2]. Nodular and curvilinear calcification was noted in the midline of In most cases of craniopagus twins, surgical separation the cranium of twin B. Absence of the hard palate was seen in twin B along with cervical vertebral anomali es. is attempted. Radiologic methods may be used in evaluating the site of contact between the two heads and the relation of one brain to the other. Vascular anatomy and continuity Cranial Computed Tomography (CT) at the junction may also be assessed. The information derived from these examinations is helpful in planning the Routine tomographic films were obtained on an EMI Mark I machine with the child ren facing upward. Pre- and postenhance­ details of surgical separation if operation is thought feasible. ment scans were obtained, with both twins being injected. We describe the radiologic investigation of one pair of partial The initial sections revealed a bony defect between the two type craniopagus twins with survival of one twin after sur­ cranial vau lts as well as a central lucent structure in the anterior gery. midline of twin B (fig . 3A). (At postmortem, this was found to be a tubular collection of fat lying immediately above the corpus cal­ losum.) A more superior section revealed two areas of calcification Case Report in the midline intimately related to the corpus callosum in twin B. No Craniopagus twins which had been delivered by cesarean section ventricular system was identified in twin B; the bodies of the lateral were transferred to Childrens Hospital of Los Angeles on the second ventricles were seen in twin A and appeared normal. Posten hance­ day of life. Twins (but not the conjunction) had been diagnosed ment studies demonstrated the superior sagittal sinuses, which did prenatally with the mother, a 3 1-year-old gravida 3, para 3 , being not appear to communicate (fig. 3B). The lateral sinuses were not large for dates. Togeth er the twin girls weighed 5, 108 g at birth. visualized. The junction was between the occipital region of twin A and the parietooccipital region of twin B. Twin B had extensive facial de­ formities with bilateral harelip and cleft palate , a bifid nose, and Cerebral Angiography widely separated eyes with a right microphthalmia and a coloboma The twins were unstable during all the investigations, particularly involving the iris. A soft-tissue mass superior to the right eye was arteriography. There was a tendency to develop hypotension, hy­ present, which was later found to be a pinched-off encephalocele pothermia, and apnea. (fig. 1). No other abnormalities were seen in twin B. Twin A had On the second day of life, an arch aortogram and left carotid dextroposition of the heart but no other extracranial abnormality. arteriogram were obtained on twin A via an umbilical artery cut­ Each twin had her own individual motor and autonomic functions, down. On day 24, a right carotid arteriogram was obtained on twin and hematologic and biochemical values were the same for both B via a percutaneous femoral artery approach, and, on day 29, children. Tilting the children caused pallor in the uppermost twin bilateral carotid and left vertebral arteriograms were undertaken on and congestion in th e other. After discussion with the parents, twin A. On day 35, a superior sagittal sinogram was attempted on radiologic investigations were undertaken to determine the feasibil­ twin A. ity of surgical separation. Bilateral carotid arteriography on twin A demonstrated no arterial crossover. Left carotid injection showed indentation of the left Skull Radiography occipital pole seen in the arterial capillary and venous phases. There was inward displacement of the superior sagittal sinus and A si ngle vertical radiograph on the second day of life with the the left lateral sinus by the herniating brain from twin B (fig. 4). children supine demonstrated some flattening of the vault at th e Th ere was no filling of the venous system of the other twin. The left Received April 15, 1982; accepted after revision August 18, 1982. I Departm ent of Radiology, Childrens Hospital of Los Angeles, P.O. Box 54700, Los Angeles, CA 90054. Address reprint requests to P. Stanley. 2 Division of Neu rosurgery, Childrens Hospital of Los Angeles, Los Angeles, CA 90054. AJNR 4:206-208, March/ April 1983 0195-6108/ 83/ 0402-0206 $00.00 © American Roentgen Ray Society AJNR:4, Mar. l Apr. 1983 CRANIOPAGUS TWINS 207 A Fi g. 1.- Frontal view shows site of conjunction and angulation of twin heads. Facial deformities of twin B and right eye abnormalities are well seen. Fig. 3. -A, Preenhancement CT scan demonstrates att itude of skull s to each other and bony defect. Midli ne lucency within brain of twin B imm ediately superior to the corpus callosum. B, En hancement scans at th is and other levels showed no apparent junc tion of two superior sagittal sinuses. Calcifi­ cation aligned with falx is in twin B. Fig. 2. - Verti cal projection demonstrates conjunction of two cranial vaults. Calcification ali gned with falx cerebri in twin B; hard palate and upper cervical spine anomali es are present. vertebral injecti on showed similar inward displacement of brain and venous sinuses. Ri ght caroti d arteriography in twin B demonstrated ingress of the pari etooccipital region across the skull defect into the cranial cavity of twin A (fig. 5A). The venous phase showed ve ins draining centrall y to a normal venous system with no drainage into twin A (fig. 5B). Th e superi or sagittal sinus was well seen and did not communicate with the other twin . To obtain further informati on regarding th e venous anatomy, a superi or sagittal sinogram was attempted on twin A via an anteri or fontanell e puncture, but satisfactory flow was not obtained. Fig. 4.-Venous phase of left carotid artery injection in twin A. Inward Surgery displacement of superior sagittal sinus (arrows) and left transverse sinus. Operation to separate the twins was carried out when they were 6 weeks of age. A scalp fl ap was refl ected and bone was removed densely adheren t to one another in this region. Fi ve or six irregular from the skull of twin B, in c luding the dense line of skull fusion. short ve ins were found to bridge between the lateral sinus of twin This exposed th e 3 x 7 cm defect between skulls where the B and dura overlying th e torcular of twin A. However, the major occipital lobe of twin B protru ded into the other cranial space venous sinuses showed no direc t communication . Additional bone indenting the dura and great sinuses. These dural layers were was taken off along the attachment, disconnecting the skulls; thi s 208 STANLEY ET AL. AJNR :4, Mar. l Apr. 1983 Fi g. 5. -Right carotid injection of twin S. A, Late arterial phase with corti­ cal arteries indicate in gress of brain tis­ sue into c ranial cavity of twin A. S, Ve­ nous phase. Central drainage with no crossover into twin A. Edge of herniated brain (arrows). A B provided improved access to th ese veins which were then divided. success [2, 4]. In our case, the dura was partly fused in the Fu sed dura was left intact in tw in A and parti ally resected from the area of skull attachment, and there were some small anas­ occipital pole of twin B. Th e separation was then complete. Th e tomotic veins extending between the lateral sinuses close scalp flap was closed over twin A's skull defect and th e other child 's to the confluence, but without a communal venous sinus. In wound was protec ted with a heavy sterile dressing preparatory to addition, herniation of the occipitoparietal lobe of twin B later grafting . through the skull defect caused some indentation and com­ Postoperative co urse in th e first twin was excell ent; she showed no neurologic defects and progressed well. Twin B had only a slight pression of the brain of twin A. These features are unusual left hemiparesis and no other new problems until th e fourth day for partial craniopagus, a defect described by O 'Connell as when sepsis developed, and she did not respond to appropriate essentially an extracranial abnormality [2]. antibioti cs. Thi s patient died on postoperative day 8. Twin A is now The object of therapy with craniopagus twins is surgical 6 years old . She has remained well, is above average in intelligence, separation. Before this can be contemplated, demonstration and her physical development is normal. New bone growth has filled of certain aspects of cranial and intracranial anatomy is in about half of th e sk ull defect and thi s area feels Quite secure, but essential. CT and plain skull radiographs are mandatory to crani oplasty may be advisa bl e in th e future. demonstrate bony and soft-tissue attachments between the skulls and cerebral hemispheres and angiography is very important to show all details of the complex vascular anat­ Discussion omy.
Load more

Recommended publications
  • Introduction
    CLINICAL NEUROSURGERY SUPPLEMENT TO NEUROSURGERY CLINICAL NEUROSURGERY VOLUME 57 VOLUME 57 CLINICAL NEUROSURGERY i Copyright Ó2010 THE CONGRESS OF NEUROLOGICAL SURGEONS All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage or retrieval system without written permission from the copyright holder. Accurate indications, adverse reactions, and dosage schedules or drugs are provided in this book, but it is possible that they may have changed. The reader is urged to review the package information data of the manufacturer of the medications mentioned. Printed in the United States of America (ISSN: 0069-4827) ii CLINICAL NEUROSURGERY Volume 57 Proceedings OF THE CONGRESS OF NEUROLOGICAL SURGEONS New Orleans, Louisiana 2009 iii Preface The 59th Annual Meeting of the Congress of Neurological Surgeons was held in New Orleans, Louisiana, from October 24-29, 2009. Volume 57 of Clinical Neurosurgery represents the official compilation of the invited scientific manuscripts from the plenary sessions, The Presidential Address by Dr David Adelson, and biographic and bibliographic information of the Honored Guest, Dr James T. Rutka. Dr Nathan Selden, Annual Meeting Chairman, and Drs Ali Rezai and Russell Lonser, Scientific Program Chair and Vice Chair respectively, organized a superb meeting which was very well attended with more than 2800 medical attendees. The theme of this year’s Annual Meeting, A Culture of Excellence, exemplified how neurosurgeons define, pursue, and measure excellence in their everyday practice and specialty. Dr David Adelson delivered his inspirational Presidential Address entitled, ‘‘Neurosurgery: A Culture of Excellence,’’ and talked about the concept of ‘‘excellence.’’ This meeting was also a joint meeting with our neurosurgical colleagues from the Neurological Society of India (NSI) and the American Association of South Asian Neurosurgeons (AASAN).
    [Show full text]
  • An Attempt at Dissolution of the Notion of Self a Thesis
    AN ATTEMPT AT DISSOLUTION OF THE NOTION OF SELF A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES OF MIDDLE EAST TECHNICAL UNIVERSITY BY DARIA SUGORAKOVA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE DEPARTMENT OF PHILOSOPHY FEBRUARY 2014 Approval of the Graduate School of Social Sciences Prof. Dr. Meliha Altunışık Director I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Ahmet İnam Head of Department This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. Assoc. Prof. Dr. Erdinç Sayan Supervisor Examining Committee Members Prof. Dr. David Grünberg (METU, Phil) Assoc. Prof. Dr. Erdinç Sayan (METU, Phil) Prof. Dr. Ayhan Sol (METU, Phil) Assoc. Prof. Dr. İskender Taşdelen (Anadolu U., Phil) Assist. Prof. Dr. Hilmi Demir (Bilkent U., Phil) I hereby declare that all information in this document has been obtained and presented in accordance with academic rules and ethical conduct. I also declare that, as required by these rules and conduct, I have fully cited and referenced all material and results that are not original to this work. Name, Last name: Signature: iii ABSTRACT AN ATTEMPT AT DISSOLUTION OF THE NOTION OF SELF Daria Sugorakova Ph.D., Department of Philosophy Supervisor: Assoc. Prof. Dr. Erdinç Sayan February 2014, 139 pages The purpose of this thesis is to provide a plausible approach to the problems of self and personal continuity that arise in various thought experiments and reported extraordinary real-life cases.
    [Show full text]
  • Craniopagus Twins: Surgical Anatomy and Embryology and Their Implications
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.1.1 on 1 January 1976. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1976, 39, 1-22 Craniopagus twins: surgical anatomy and embryology and their implications J. E. A. O'CONNELL1 From the Department of Neurological Surgery, St. Bartholomew's Hospital, London SYNOPSIS Craniopagus is of two types, partial and total. In the partial form the union is of limited extent, particularly as regards its depth, and separation can be expected to be followed by the survival of both children to lead normal lives. In the total form, of which three varieties can be recognized, the two brains can be regarded as lying within a single cranium and a series of gross intracranial abnormalities develops. These include deformity of the skull base, deformity and displacement of the cerebrum, and a gross circulatory abnormality. It is considered that these and other abnormalities, unlike the primary defect, which is defined, are secondary ones; explanations for them, based on anatomy and embryology, are put forward. The implications of the various anomalies are discussed and the ethical aspects of attempted separation in these major unions considered. Protected by copyright. The birth of conjoined twins is an infrequent future. The practical problems resulting from occurrence. Its incidence is estimated as one in disordered anatomy are discussed and their 50 000 births (Potter, 1961). The union is a solution, complete or partial, described. The cephalic one in 2.0% which makes the incidence abnormal anatomy is analysed and related to of craniopagus twins one in 2.5 million births.
    [Show full text]
  • Undergraduate Journal of Psychology University of British Volumecolumbia’S 1 Undergraduate April 2012 Journal of Psychology Volume 1 April 2012
    Volume 1, April 2012 ISSN 1927-2820 (Print) ISSN 1927-2839 (Online) UndergraduateUniversity of Journal British Columbia’s of Psychology Editor-in-Chief: David W. –L. Wu http://ubcujp.psych.ubc.ca UBC’s Undergraduate Journal of Psychology University of British VolumeColumbia’s 1 Undergraduate April 2012 Journal of Psychology Volume 1 April 2012 Editor-in-Chief David W. –L. Wu Contents Editorial Board Jenn Ferris, Section Editor: Behavioural Neuroscience Editor’s Note 1 Kaitlyn M. Goldsmith, Section Editor: Clinical David W. –L. Wu Amara Sarwal, Section Editor: Cognitive Virginie Cousineau, Section Editor: Developmental Metaplasticity: A new frontier in the neural representation of memory 3 Ashley Whillans, Section Editor: Social, Personality, & Health Dano Morrison Jade McGregor, Associate Editor: Social, Personality, & Health Psychology: A closer look at what psychologists bring to the table 15 Elizabeth Laliberte Reviewers Sophia Bobovski Bri Glazier Craniopagus: Overview and the implications of sharing a brain 21 Carly Thornton Carol Chu Jordan Squair Kurtis Stewart Adam Baimel Christina van den Brink Sepehr Nassiri Pedophilia and brain function 29 Diana Choi Taylor Davis Po Liu Katharina Block Tess Walker Thariq Badiudeen Robyn Jackowich Too much sex, a mental disorder? Examining both sides of the debate on Savannah Nijeboer Zarina Giannone hypersexual disorder 35 Xaiolei Deng Patrick Dubois Xijuan Zhang Setareh Shayanfar Tai Khuong Startle reflex as a physiological measure of emotion regulation 45 Agnes Cywinska Yang Fei (also Statistics
    [Show full text]
  • The Spectre of Court-Sanctioned Sacrificial Separation of Teenage Conjoined Twins Against Their Will
    The spectre of court-sanctioned sacrificial separation of teenage conjoined twins against their will Author Davis, Colleen Published 2014 Journal Title Journal of Law and Medicine Copyright Statement © 2014 Thomson Legal & Regulatory Limited. The attached file is reproduced here in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version. Downloaded from http://hdl.handle.net/10072/65240 Link to published version http://www.thomsonreuters.com.au/catalogue/ProductDetails.asp?ID=965 Griffith Research Online https://research-repository.griffith.edu.au The spectre of court-sanctioned sacrificial separation of teenage conjoined twins against their will Colleen Davis* In a recent decision of the Indian Supreme Court, judges foreshadowed authorising separation of teenage conjoined twins where both would die if not separated but where the operation could save only one. The absence of medical information advising separation precluded such a decision in the case at hand. However, the case raises a number of difficult legal and ethical questions that judges would have to consider before authorising sacrificial separation of these or other non-infant conjoined twins. INTRODUCTION The recent decision of the Indian Supreme Court in Dhasmana v Union of India (2013) 9 SCC 475 (Dhasmana) is likely to reignite the debate about the moral, ethical and legal issues associated with sacrificial separation of conjoined twins. Dhasmana is the first conjoined twin court case that does not involve infant conjoined twins. In three previous cases – the Lakewood case in 1977, Re A (Children) (Conjoined Twins: Surgical Separation) [2000] 4 All ER 961 (Re A (Children)) and Queensland v Nolan [2002] 1 Qd R 454 (Nolan) – courts were asked to declare lawful surgery in which one infant twin was sacrificed to give the other the chance at a longer life.
    [Show full text]
  • James T. Goodrich, MD, Phd, 1946–2020: a Historical Perspective and His Contributions to Craniopagus Separation
    HISTORICAL VIGNETTE J Neurosurg Pediatr 26:454–460, 2020 James T. Goodrich, MD, PhD, 1946–2020: a historical perspective and his contributions to craniopagus separation *Brandon M. Lehrich, BS,1 Nolan J. Brown, BS,2 Shane Shahrestani, MS,3 Ronald Sahyouni, MD, MS, PhD,2,4 and Frank P. K. Hsu, MD, PhD5 1Department of Biomedical Engineering, University of California, Irvine; 2School of Medicine, University of California, Irvine; 3Keck School of Medicine of University of Southern California, Los Angeles; 4Medical Scientist Training Program, University of California, Irvine; and 5Department of Neurosurgery, UCI Health, School of Medicine, Irvine, California 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 crani- opagus 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. https://thejns.org/doi/abs/10.3171/2020.5.PEDS20371 KEYWORDS James Goodrich; craniopagus twins; multistaged surgery; craniofacial surgery; neurosurgery history; congenital; conjoined twins NTERNATIONALLY renowned pediatric neurosurgeon, Dr.
    [Show full text]
  • 44Th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016
    Childs Nerv Syst (2016) 32:1957––2040 DOI 10.1007/s00381-016-3209-9 ABSTRACTS 44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016 This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher. Graciela Zuccaro, ISPN President scan were compatible with zvae. Both mothers reported symptoms of ZV Mami Yamasaki, ISPN 2016 Annual Meeting Chair fever in the first months of pregnancy. Assesment and follow up by the Graham Fieggen, ISPN 2016 Scientific Committee Chair neurorehabilitation team demonstrated severe neurologial disability with up- Tony Figaji, ISPN 2016 Scientific Committee Co-Chair per motor neuron syndrome. CONCLUSIONS:Zvae is a threatening and rapidly spreading outbreak with high potential for mortality and morbidity. The pediatic neurosurgeon must PLATFORM PRESENTATIONS take part in the management task force helping to establish differential diag- nosis and to rapidly separate true cases from those related to neurosurgical Monday, 24 October 2016 diseases. 09:00 – 09:32 Keywords: Zika virus, encephalitis, microcephaly, hidrocephalus. Platform presentations 1: Fetal Diagnosis and Management PF-002 Special topic: Fetal diagnosis and management PF-001 Special topic: Fetal diagnosis and management First 50 fetal in-utero microsurgical myelomeningocele repairs: critical comparison of neurosurgical and maternal outcomes to the MOMS trial Zika virus fetal encephalitis outbreak: what is the role of the pediatric neurosurgeon in the response
    [Show full text]
  • Epigastric-Heteropagus Twins Recorded in Madras Presidency in 1789
    IJHS | VOL 54.3 | SEPTEMBER 2019 ARTICLES Epigastric-heteropagus Twins Recorded in Madras Presidency in 1789 Ramya Ramana,∗, Anantanarayanan Ramanb a School of Medicine, University of Notre Dame, Fremantle, WA 6160, Australia b Charles Sturt University, PO Box 883, Orange, NSW 2800, Australia (Received 08 February 2019) Abstract Twinning is rare in humans, and conjoined twins are rarer. One type of conjoined twins is ‘parasitic twins’, also referred to as ‘heteropagus twins’. This kind of birth anomaly presents asymmetrically joined twins, one of which will usually be intensely deformed and depend parasitically on the other, the near-normal one. We present here the report ‘An account of a monster of the human species’ written from Fort St. George, Madras and published in the Philosophical Transactions of the Royal Society of London in 1789. This report consists of two letters: one from Baron Reichel to Sir Joseph Banks and the other from James Anderson to Baron Reichel. The Reichel and Anderson letters impress as the earliest formal record of heteropagus twins in India. The morphogenesis of heteropagus twinning is still unclear. The origin of heteropagus twins is explained as monozygotic by some obstetricians and as dizygotic by others. Until the mid-20th century, medical parlance referred to these humans as monsters and their deformities as monstrosities, which was unfortunate. Key words: Artwork, Dizygotic, James Anderson, Thomas Joseph Reichel, Machilipatnam, Monozygotic, Parasitic twins. 1 Introduction external stimuli, the mechanism underlying the induc- tion of spontaneous twinning in humans remains unex- plained. When possible, surgeons separate the conjoined Twinning is rare in humans, but conjoined twins individuals surgically.
    [Show full text]
  • Craniopagus: Overview and the Implications of Sharing a Brain Jordan Squair1 1School of Kinesiology, University of British Columbia
    CLINICAL Literature Review Craniopagus: Overview and the implications of sharing a brain Jordan Squair1 1School of Kinesiology, University of British Columbia Edited by: Amara Sarwal, Department of Psychology, University of British Columbia. Received for review January 8, 2012, and accepted February 27, 2012. Copyright: © 2012 Squair. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivates License, which permits anyone to download and share the article, provided the original author(s) are cited and the works are not used for commercial purposes or altered in any way. Abstract Craniopagus twins, who are conjoined at the head, are uncommon and often misunderstood. While craniopagus is rare in itself, Krista and Tatiana Hogan are unique even among craniopagus twins: their brains are connected. In this review, I will explore the history of craniopagus as well as our current understanding of the malformation. Furthermore, I will discuss surgical separation techniques, classification systems, and how these have led to higher survival rates in separated craniopagus twins. Surgical separation of craniopagus twins is perhaps the most formidable of all neurosurgery operations, particularly in the presence of shared neural tissue. Krista and Tatiana fall into this daunting category. The risk of neural damage, coupled with circulatory complications, led Krista and Tatiana’s physicians to conclude a separation would be too dangerous. Consequently, Krista and Tatiana are left with a connection that is both novel to documented research and exquisitely mysterious. They possess what their pediatric neurosurgeon Dr. Doug Cochrane has called a “thalamic bridge” (Dominus, 2011a). Krista and Tatiana’s thalamic bridge will provide significant insight into the study of cognition and behaviour, and may even have significant implications to the philosophy of mind.
    [Show full text]
  • A Successful Separation of Total Vertical Craneopagus Conjoined Twins in Costa Rica
    Case Report Open Access J Neurol Neurosurg Volume 14 Issue 3 - October 2020 DOI: 10.19080/OAJNN.2020.14.555887 Copyright © All rights are reserved by Juan Luis Segura Valverde A Successful Separation of Total Vertical Craneopagus Conjoined Twins in Costa Rica Juan Luis Segura Valverde1*, Justiniano Zamora Chaves2, Edgar Jimenez Masis3, Humberto Trejos Fonseca4, Juan Luis Segura Masis5 and Isabela Peña Pino2 1Department of Pediatric Neurosurgery, National Children’s Hospital Dr. Carlos Saenz Herrera, San José, Costa Rica 2Universidad de Ciencias Médicas Andres Vesalio Guzman, San José, Costa Rica Submission: October 05, 2020; Published: October 20, 2020 *Corresponding author: Juan Luis Segura Valverde, Department of Pediatric Neurosurgery, National Children’s Hospital Dr. Carlos Saenz Herrera Calle 20 Avenida 0, Paseo Colon San Jose, 10103, Costa Rica Abstract - mation. The broad phenotypic variation within this group requires an extensive workup to determine the internal shared anatomy, since a sepa- rationConjoined surgery maytwins require that are dividing attached not at only the skinhead and are calvarium, classified asbut craneopagus also dura mater, twins venous and they circulation represent and an even extremely brain cortex.rare congenital We present malfor such a case in a 2-year-old male pair of type I total vertical craneopagus twins who were surgically separated successfully at the National Children’s Hospital of Costa Rica. Given the highly complex shared venous morphology, this single surgery required the division of a circumferential dural sinus, a common torcula herophili and abundant secondary venous drainage. To achieve this, novel techniques were implemented to optimize surgical time and blood loss as well as attain an equitable distribution of structures.
    [Show full text]
  • Conjoined Twins Philosophical Problems and Ethical Challanges
    The conversation this week focuses on the rights of individuals through the shared experience of conjoined twins. Concepts like identity, medical ethics, and the doctrine of double effect only begin to describe the places this important work poses. Fasten your seatbelt for a tour de force philosophical enquiry. * *Access to this article was granted through Oxford Journals as a free sample. http://services.oxfordjournals.org/my_account/allsampleissue. dtl Journal of Medicine and Philosophy, 41: 41–55, 2016 doi:10.1093/jmp/jhv037 Advance Access publication December 14, 2015 Conjoined Twins: Philosophical Problems and Ethical Challenges JULIAN SAVULESCU* University of Oxford, Oxford, UK INGMAR PERSSON University of Oxford, Oxford, UK *Address correspondence to: Julian Savulescu, Oxford Uehiro Centre for Practucal Ethics, Suite 8, Littlegate House, 16/ 17 St Ebbe’s St., Oxford, OX1 1PT. E-mail: [email protected] We examine the philosophical and ethical issues associated with conjoined twins and their surgical separation. In cases in which there is an extensive sharing of organs, but nevertheless two distinguishable functioning brains, there are a number of philosophical and ethical challenges. This is because such conjoined twins: 1. give rise to puzzles concerning our identity, about whether we are identical to something psychological or biological; 2. force us to decide whether what matters from an ethical point of view is the biological life of our organisms or the existence of our consciousness or mind; 42 Julian Savulescu and Ingmar Persson 3. raise questions concerning when, if ever, it is morally acceptable to sacrifice one of us to save another; 4.
    [Show full text]
  • June 2020 Volume 41 Pp 943–1134
    JUNE 2020 AJNR VOLUME 41 PP 943–1134 JUNE 2020 THE JOURNAL OF DIAGNOSTIC AND VOLUME 41 INTERVENTIONAL NEURORADIOLOGY NUMBER 6 WWW.AJNR.ORG Perspectives on neuroradiology from the COVID-19 outbreak Preoperative evaluation of craniopagus twins Improved detection of focal cortical dysplasia Resting-state brain activity in comatose postanoxic patients Official Journal ASNR • ASFNR • ASHNR • ASPNR • ASSR FRED™ Flow Re-Direction Endoluminal Device FLOW DIVERSION. SIMPLIFIED. ™ MicroVention Worldwide Innovation Center PH +1 714.247.8000 35 Enterprise Aliso Viejo, CA 92656 USA MicroVention UK Limted PH +1 44 (0) 191 258 6777 MicroVention Europe S.A.R.L. PH +33 (1) 39 21 77 46 MicroVention Deutschland GmbH PH +49 211 210 798-0 Web microvention.com The New Standard of Ease and Simplicity in Flow Diversion Treatment. Reliable Precise Versatile Design1,2,3 Placement Portfolio Unique construction Easily position and deploy The first low profile delivers both remarkable FRED™ Device in specific, delivery system offered ease of use and excellent targeted locations4,5,6 in combination with flow diversion1,2,3 large diameter and long length options References: 1. TR11-211 2. TR13-171 3. TR15-055 4. TR13-192 5. TR15-072 6. TR19-145 The Flow Re-Direction Endoluminal Device (FRED™) System is indicated for use in the internal carotid artery from the petrous segment to the terminus for the endovascular treatment of adult patients (22 years of age or older) with wide-necked (neck width ≥ 4 mm or dome-to-neck ratio < 2) saccular or fusiform intracranial aneurysms arising from a parent vessel with a diameter ≥ 2.0 mm and ≤ 5.0 mm.
    [Show full text]