title: Functional magnetic resonance imaging in adult craniopagus for presurgical evaluation.
abstract: Cranially conjoined twins are rare and pose unique challenges in the preoperative evaluation of cerebral language function. The authors report on their experience in the functional magnetic resonance (fMR) imaging evaluation of adult craniopagus (temporoparietooccipital fusion) to evaluate hemispheric language dominance and the eloquent language areas in the preoperative planning stages. Conventional clinical imaging hardware originally designed for individuals was adapted and tailored for use in the twins. They were assigned a selection of language tasks while undergoing fMR imaging. Significant blood oxygen level-dependent activations were detected in the main language regions in each twin, that is, the inferior frontal gyrus (around the Broca area), the middle and superior temporal lobes (around the Wernicke area) together with the inferior parietal lobe, and the middle and superior frontal gyri. Overall, the right-handed twin was strongly left lateralized for language, whereas the left-handed twin showed more bilateral activation during language tasks. Noninvasive language mapping with the aid of fMR imaging has been demonstrated for the first time in total craniopagus.
authors.affiliation: Departments of Neuroradiology, Research, and Neurology, National Neuroscience Institute, Singapore.
authors.forename: Yi-Ching Lynn
authors.initials: YC
authors.lastname: Ho
authors.forename: Keith Yu-Ching
authors.initials: KY
authors.lastname: Goh
authors.forename: Xavier
authors.initials: X
authors.lastname: Golay
authors.forename: Wee-Tin
authors.initials: WT
authors.lastname: Hong
authors.forename: Shih-Hui
authors.initials: SH
authors.lastname: Lim
authors.forename: Andrew Beng-Siong
authors.initials: AB
authors.lastname: Pan
authors.forename: Violet Gek-Eng
authors.initials: VG
authors.lastname: Chua
authors.forename: Francis
authors.initials: F
authors.lastname: Hui
authors.forename: Yih-Yian
authors.initials: YY
authors.lastname: Sitoh
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000601:surgery*; D001931:Brain Mapping; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D011300:Preoperative Care; D014428:Twins, Conjoined / Q000473:pathology* / Q000601:surgery*