Craniopagus: the Suriname-Amsterdam conjunction.
OBJECTIVE
A case of a Suriname female occipito-parietal to occipito-parieto-temporal craniopagus twins is described. The girls were transferred to the VU University Medical Center (VUmc) in Amsterdam, the Netherlands, for further diagnostics and to analyze whether surgical separation was feasible and ethically justifiable. The multifactorial aspects of different treatment options are discussed.


METHODS
The twins underwent multiple investigations by a multidisciplinary team. Advanced imaging techniques with 3D-CT scan, MRI and MRA scans, image fusion techniques and, most importantly, cerebral angiography with balloon occlusion tests were performed.


CONCLUSIONS
Because of a shared venous ring, with preferential drainage to the left child, and which endovascular balloon occlusion showed could not be separated, surgical separation of the twins with a fair chance of survival without additional neurological damage and with prospects of a good quality of life was regarded as impossible. In accordance with the parents' wishes, the twins were not separated and offered optimal integral conservative treatment.
Department of Neurosurgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. w.vouwerkerk@vumc.nl
W J R
WJ
van Ouwerkerk
R
R
van den Berg
C E
CE
Allison
R
R
Sibarani
J A E
JA
van Wijk
L M E
LM
Smit
B J
BJ
ten Voorde
J
J
de Munck
C A
CA
Kurk
M E
ME
Velthuys
E
E
van Leeuwen
L
L
Bemmel
W P
WP
Vandertop
D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D002550:Cerebral Veins / Q000473:pathology / Q000601:surgery; D003392:Cranial Sinuses / Q000473:pathology / Q000601:surgery; D005260:Female; D006257:Head / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods; D008953:Models, Anatomic; D009426:Netherlands; D009493:Neurosurgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010348:Patient Care Team; D013518:Surgery, Plastic / Q000379:methods; D013532:Suriname; D016896:Treatment Outcome; D014428:Twins, Conjoined / Q000601:surgery*