title: Separation of craniopagus Siamese twins using cardiopulmonary bypass and hypothermic circulatory arrest.
abstract: Occipitally joined craniopagus Siamese twins were separated with the use of cardiopulmonary bypass and hypothermic circulatory arrest. The 7-month-old infants shared a large sagittal venous sinus that precluded conventional neurosurgical approach because of risk of exsanguination and air embolism. After craniotomy and preliminary exposure of the sinus, each twin underwent sternotomy and total cardiopulmonary bypass with deep hypothermia. Hypothermic circulatory arrest allowed safe division and subsequent reconstruction of the sinus remnants. Several unusual problems were encountered, including transfusion of a large blood volume from one extracorporeal circuit to the other through the common venous sinus, deleterious warming of the exposed brain during circulatory arrest, and thrombosis of both pump oxygenators. Both infants survived, although recovery was complicated in each by neurologic injury, cranial wound infection, and hydrocephalus. This case demonstrates the valuable supportive role of cardiopulmonary bypass and hypothermic circulatory arrest in the management of complex surgical problems of otherwise inoperable patients.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: D E
authors.initials: DE
authors.lastname: Cameron
authors.forename: B A
authors.initials: BA
authors.lastname: Reitz
authors.forename: B S
authors.initials: BS
authors.lastname: Carson
authors.forename: D M
authors.initials: DM
authors.lastname: Long
authors.forename: C R
authors.initials: CR
authors.lastname: Dufresne
authors.forename: C A
authors.initials: CA
authors.lastname: Vander Kolk
authors.forename: L G
authors.initials: LG
authors.lastname: Maxwell
authors.forename: D M
authors.initials: DM
authors.lastname: Tilghman
authors.forename: D G
authors.initials: DG
authors.lastname: Nichols
authors.forename: R C
authors.initials: RC
authors.lastname: Wetzel
mesh_terms: D001930:Brain Injuries / Q000209:etiology; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005069:Evaluation Studies as Topic; D006257:Head; D006324:Heart Arrest, Induced; D006489:Hemostatic Techniques; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007036:Hypothermia, Induced; D007223:Infant; D008297:Male; D009778:Occipital Lobe; D010106:Oxygenators / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D014428:Twins, Conjoined / Q000601:surgery*