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Craniopagus twins
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CRANIOPAGUS TWINS RE: Khan ZH, Tabatabai SA, Saberi H. Anesthetic and surgical experience in a case of total vertical craniopagus. Surg Neurol 1999;52:62–7. The authors report a case of craniopagus twins and describe the angiographic and anatomical findings and the surgical procedure. Separation was attempted on an emergency basis when the twins were a year old; both died during the procedure. To the Editor: I was fascinated by the report of Khan et al. This gives me an opportunity to vent thoughts I have had now for over 30 years, because we had the experience of craniopagus twins in 1962–1963. These twins were brought to us by a couple who lived some distance from our medical center, and they wanted to “give them to us,” which, of course, we could not accept. They showed very little interest and we communicated directly with them. Multiple procedures were carried out on these babies. First of all, one of the babies, baby “B”, was smaller than baby “A,” had a cleft palate and harelip, and, in fact, had to be tube fed for some weeks. However, both of these children finally gained weight and were fairly reactive to their environment. Multiple procedures were done to provide scalp and to effect the eventual separation, which we anticipated doing when they were about a year of age. This was all done in the days before EMI scans or MRIs and, although we did do electroencephalograms, which showed abnormalities in the smaller baby “B,” we did arteriograms with some difficulty, because their vessels were so small. It was obvious that they both had normal circulation, though there was a good deal of crossflow, and the dye injected into one baby was transposed into the other baby, who showed a normal urogram postangiogram. After multiple scalp procedures and a gradual effort to remove the bony connection between the two babies, a separation was effected at the age of about a year, with two anesthetic teams and multiple transfusions. Baby “B,” the smaller baby, died about the end of the procedure. Baby “A,” the larger baby, had his scalp closed due to the previous 0090-3019/99/$–see front matter
successful skin procedures, but he did not survive more than 24 hours. At autopsy there was no other congenital anomaly found and no heart defects were found in either child. Great credit went to the nurses who cared for these babies and brought them into a condition where they could be operated on, and to the plastic surgeon who did multiple procedures to provide adequate scalp to close at the end of the procedure. There was a common sagittal sinus and, in retrospect, there was a lot more adhesion between the two brains than we anticipated. However, I think if we had been able to decide that baby “B” would not survive as a normal child and could have sacrificed that child for the other one, we could have had one normal baby. There have been a number of craniopagus separations, but almost invariably, if there is a serious connection between the two babies, one of the children is severely retarded. Probably in the long run, society and ethics committees will have to decide whether it is satisfactory to sacrifice one child for the benefit of the other normal child. Eben Alexander, Jr., M.D. Winston–Salem, North Carolina PII S0090-3019(99)00151-2
NEURONAVIGATION IN PITUITARY SURGERY RE: Warnke PC. Neuronavigation and surgical neurology: the beginning of a new age or the end of an old age? Surg Neurol 1999;52:7–12. The author questions the value of neuronavigation in tumor surgery, stating that its potential benefit is still unproved. To the Editor: Image-guided navigation in the transsphenoidal approach to the sella was introduced in the early 1960s by the combined use of fluoroscopy with an image intensifier for lateral guidance (and A-P view if necessary) and the surgical microscope for direct midline visualization of the anatomical structures. © 1999 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
CRANIOPAGUS TWINS RE: Khan ZH, Tabatabai SA, Saberi H. Anesthetic and surgical experience in a case of total vertical craniopagus. Surg Neurol 1999;52:62–7. The authors report a case of craniopagus twins and describe the angiographic and anatomical findings and the surgical procedure. Separation was attempted on an emergency basis when the twins were a year old; both died during the procedure. To the Editor: I was fascinated by the report of Khan et al. This gives me an opportunity to vent thoughts I have had now for over 30 years, because we had the experience of craniopagus twins in 1962–1963. These twins were brought to us by a couple who lived some distance from our medical center, and they wanted to “give them to us,” which, of course, we could not accept. They showed very little interest and we communicated directly with them. Multiple procedures were carried out on these babies. First of all, one of the babies, baby “B”, was smaller than baby “A,” had a cleft palate and harelip, and, in fact, had to be tube fed for some weeks. However, both of these children finally gained weight and were fairly reactive to their environment. Multiple procedures were done to provide scalp and to effect the eventual separation, which we anticipated doing when they were about a year of age. This was all done in the days before EMI scans or MRIs and, although we did do electroencephalograms, which showed abnormalities in the smaller baby “B,” we did arteriograms with some difficulty, because their vessels were so small. It was obvious that they both had normal circulation, though there was a good deal of crossflow, and the dye injected into one baby was transposed into the other baby, who showed a normal urogram postangiogram. After multiple scalp procedures and a gradual effort to remove the bony connection between the two babies, a separation was effected at the age of about a year, with two anesthetic teams and multiple transfusions. Baby “B,” the smaller baby, died about the end of the procedure. Baby “A,” the larger baby, had his scalp closed due to the previous 0090-3019/99/$–see front matter
successful skin procedures, but he did not survive more than 24 hours. At autopsy there was no other congenital anomaly found and no heart defects were found in either child. Great credit went to the nurses who cared for these babies and brought them into a condition where they could be operated on, and to the plastic surgeon who did multiple procedures to provide adequate scalp to close at the end of the procedure. There was a common sagittal sinus and, in retrospect, there was a lot more adhesion between the two brains than we anticipated. However, I think if we had been able to decide that baby “B” would not survive as a normal child and could have sacrificed that child for the other one, we could have had one normal baby. There have been a number of craniopagus separations, but almost invariably, if there is a serious connection between the two babies, one of the children is severely retarded. Probably in the long run, society and ethics committees will have to decide whether it is satisfactory to sacrifice one child for the benefit of the other normal child. Eben Alexander, Jr., M.D. Winston–Salem, North Carolina PII S0090-3019(99)00151-2
NEURONAVIGATION IN PITUITARY SURGERY RE: Warnke PC. Neuronavigation and surgical neurology: the beginning of a new age or the end of an old age? Surg Neurol 1999;52:7–12. The author questions the value of neuronavigation in tumor surgery, stating that its potential benefit is still unproved. To the Editor: Image-guided navigation in the transsphenoidal approach to the sella was introduced in the early 1960s by the combined use of fluoroscopy with an image intensifier for lateral guidance (and A-P view if necessary) and the surgical microscope for direct midline visualization of the anatomical structures. © 1999 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010