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15-Year Assessment of Craniopagus Twins and the Variables that Lead to Successful Separation

Donald J. Harvey B.S. Ali Totonchi M.D. Arun K. Gosain M.D.
Rainbow Babies and Children's Hospital of Case Western Reserve University

Presenter: Donald J. Harvey


Director Name:

Author Category: Physician in Practice
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Purpose: Craniopagus twins are the rarest form of conjoined twins, occurring at a rate of 0.6 per million births and a female: male ration of 4:1. In order to understand the factors that contribute to successful separation in the modern era of neuroimaging and modern surgical techniques, we reviewed and analyzed reported cases since 1995.

Methods: All reported cases of craniopagus twin separation attempts from 1995 to September 2009 were identified using PubMed, including one unreported case from our institution (Ntwins=15). The articles were used to build a categorical database containing information on each twin pair including sex, date of birth, date of surgery, multiple vs. single stage surgery, angular vs. vertical conjoining, nature of shared cerebral venous system, and the presence of other comorbidities identified as cardiovascular, genitourinary, and craniofacial. The data was analyzed using Fisher's Exact Test and non-linear mixed effects regression model.

Results: Only two variables were statistically significant for successful separation including the presence of vertical craniopagus (p-value <0.001) and the absence of genitourinary anomalies (p-value = 0.017). No statistical significance was attributed to the nature of the shared cerebral venous drainage (p-value 0.29) or the other variables examined.

Conclusion: Our 15 year/15 case analysis indicates that vertical craniopagus twins and twins without genitourinary abnormalities have the highest likelihood of successful separation. Additional factors possibly associated with successful separation include the nature of the shared sinus system, surgery at a young age, and the use of staged separations.

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