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N Engl J Med. 2019 Jan 24;380(4):358-364. doi: 10.1056/NEJMoa1805132.

Separation of Craniopagus Twins by a Multidisciplinary Team.

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From the Divisions of Neurosurgery (G.G.H., B.C.K., P.B.S.) and Plastic and Reconstructive Surgery (J.A.T.), Children's Hospital of Philadelphia, and the Department of Neurosurgery, Hospital of the University of Pennsylvania (G.G.H., P.J.M., T.M.F., B.C.K., P.B.S.) - both in Philadelphia.


Conjoined twins who are classified as craniopagus (joined at the cranium) have a rare congenital anomaly. Despite advances in surgical techniques and critical care, the rate of complications and death is still high among twins with total fusion in which the superior sagittal sinus is shared. Here, we describe total-fusion craniopagus twins who at 10 months of age underwent successful surgical separation performed by a multidisciplinary team. Computer-aided design and modeling with a three-dimensional printer, custom-designed cranial distraction and constriction devices, and intraoperative navigation techniques were used. These techniques allowed for separation of the twins at an early age and harnessed the regenerative capacity of their young brains.

[Indexed for MEDLINE]

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