The separation of Guatemalan craniopagus twins.
METHODS
The particularities of the surgical procedure for the separation of craniopagi twins performed at UCLA in 2002 are presented. The main difficulty for the neurosurgeons was that the twins shared a common sagittal sinus and that one of the sisters had a poorly developed collateral venous system, thus anticipating a set of postoperative clinical problems. During surgery, the response of the brain to the progressive occlusion of the venous bridges was monitored with EEG and Doppler ultrasound. One of the sisters had a large intracerebral hematoma that was evacuated and later developed hydrocephalus, which was treated with a ventriculoperitoneal shunt.


RESULTS
One of the sisters had a basically uneventful recovery while the other contracted E. coli meningitis 8 months after surgery, thus impairing her motor and cognitive development.


CONCLUSIONS
The details and intricacies of the anesthesia and plastic surgery are also outlined.
Frazee
John
J
Division of Neurosurgery, UCLA David Geffen School of Medicine, PO Box 957039, Los Angeles, CA 90095-7039, USA.
Fried
Itzhak
I
Kawamoto
Henry
H
Lazareff
Jorge
J
Nieto
Jaime
J
Patel
Swati
S
Urata
Mark
M
van de Wiele
Barbara
B
D000758:Anesthesia / Q000379:methods; D001921:Brain / Q000473:pathology / Q000601:surgery*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006166:Guatemala; D006801:Humans; D007223:Infant; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D009493:Neurosurgery / Q000379:methods; D011183:Postoperative Complications; D012886:Skull / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D013518:Surgery, Plastic / Q000379:methods*; D016896:Treatment Outcome; D014428:Twins, Conjoined / Q000601:surgery*