title: Anesthetic and surgical experience in a case of total vertical craniopagus.
abstract: BACKGROUND
  A case of craniopagus twins is presented. The twins were attached to each other at the parietal vertex with an interaxis angle of 180 degrees and an interface angle of 90 degrees. To assess the bony, vascular, and nervous system interconnections, the twins underwent computerized tomographic scanning and cerebral angiography under inhalational general anesthesia.
  
  
  METHODS
  To provide adequate skin, tissue expanders were implanted under the scalp at 3 and 7 months of age. Separation became necessary at 1 year of age on an emergency basis, because of respiratory complications in the small twin. Profuse bleeding and hypovolemia led to the death of the healthy big twin. While one would expect that at least one of the twins could have been saved, the small twin also succumbed to air emboli and hypotension hours later. Postmortem examination revealed that the brains were joined at both medial and lateral hemispheric surfaces and shared a common circumferential sinus.
  
  
  CONCLUSIONS
  This case was quite different as regards cerebral anatomy compared to those already reported in the literature.
authors.affiliation: Department of Anesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Islamic Republic of Iran.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Khan
authors.forename: S A
authors.initials: SA
authors.lastname: Tabatabai
authors.forename: H
authors.initials: H
authors.lastname: Saberi
mesh_terms: D000768:Anesthesia, General; D001921:Brain / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D012886:Skull / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014428:Twins, Conjoined / Q000601:surgery