Craniopagus twins: Surgical anatomy and embryology and their implications

Craniopagus twins: Surgical anatomy and embryology and their implications

ABSTRACTS 1094 salvage, and after 48 hr there is virtually no hope of testicular survival. For the latter group, the author advises orchidectomy. Fe...

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salvage, and after 48 hr there is virtually no hope of testicular survival. For the latter group, the author advises orchidectomy. Fear of wound infection has caused the author to delay fixation of the opposite testis to a later date, a dangerous and unacceptable approach. Likewise, orchidectomy as a primary procedure is not generally practiced. Although the involved testis may macroscopically appear necrotic, there are definite areas remaining which are histologically viable.-f.ewis Spirz Priapism in Twins. P. Mollord, J. M. Morichaf, and G. Sooillet. Ann Chir Infant 17:173-176


June), 1976. Two cases of priapism in twins of 124 yr are described, both after a viral infection. Etiology remained unknown, a hemopathy having been excluded. Both were cured, one by saphenocavernous anastomosis, the other by anticoagulative treatment. Prognosis concerning erectile




Jaussi-Bovet Congenital Absence of the Penis. W. G. John-

ston, Jr., G. W. Yeotman, and J. W. Weigel. J. Ural 117:508-512 (April), 1977. Congenital absence of the penis is a rare condition which should be diagnosed at birth. If the patient is immediately and unequivocally assigned the female gender, she can develop into a well adjusted women who is emotionally and sexually functional. Early castration is advised and the median raphe of the scrotum should be fixed to the underlying fascia to resemble labia. The scrotal skin is thus preserved for vaginoplasty, which may be performed at puberty.--George Holcomb



Simpson. J Bone Joint Surg 598:143-151 1977.

A study of 40 children with spinal tumors revealed the difficulties of diagnosis. The most common complaints were weakness of a limb, pain in the back with or without radiation to a limb, and sphincter disturbance. Physical findings of muscle weakness, pathologic reflexes, sensory loss, the presence of a mass, and spinal muscle spasm were common. Radiologic changes of neural arch and vertebral erosion were the most common findings, but in only 55?; were there changes in the plain films. Myelography was carried out in 25 children in all but two of whom the lesion or a block was ‘demonstrated. Manometric tests on the CSF were of limited value, but a raised protein level was a most significant finding. Laminectomy was carried out in 29 children, and in 10 of these children spinal instability developed, giving rise to deformity most severe in the cervical and thoracic spine in the form of “swan neck” deformity or scoliosis. Attempted prevention and treatment of these deformities is discussed.--M. G. H. Smith Sub-Capital Coxa Valga After Varus Osteotomy for Congenital

Joint Surg 598:159-165


In a review of 47 patients treated for congenital dislocation of the hip by varus osteotomy, 6 cases of coxa valga were subsequently found. This appears to be related to the development of a relatively horizontal growth plate, but an analysis of the 6 cases does not reveal a cause for this. The production of a partially uncovered femoral head as a result of the sub-capital coxa valga must be regarded as a serious long term complication.-_. G. H.

Aspects of


F. Afves. J Bone Craniopagur

A technique is described in which a stainless steel rod is placed on the convex side of the spinous processes of a scoliosis curve, and to which the spinous processes and posterior elements are then wired. This device as a reduction and stabilizing device accompanied by spinal fusion was used in 100 children, the average correction of the curves obtained being 45 per cent.-M. G. H. Smith Olthopaedic


Turnours and

D. A. (May), 1977.


(May), 1977.

Children. R. D. Fraser, D. C. Paterson,

Dislocation of the Hip.

Jones. J Bone Joint Surg 598:152-158

A Technique of Correction and Internal Fixation for Scoliosis. J. Resino and



D. A.


Embryology and

O’Connell. 1976

SYSTEM Surgical



Their Implications. J. E. A.

J Neural Neurosurg



Craniopagus can be “partial,” which can be separated to produce survival of both children (the fusion being superficial), or “total,” the two brains being contained in a common cranium, separation resulting in only one survivor. In the total form, the heads are joined at the vertex and three varieties occur, depending on the rotation of the heads about the long axis: (1) both faces in the same direction, (2)



faces rotated 140”-180”. and (3) faces rotated 90”. Prior to separation, angiography is essential, particularly the venous phase. in the total form there is often crossed venous drainage, the superior sagittal sinus being absent. and separation always produces large defects in the scalp, skull. and meninges. Brain distortions are produced by compression and depend on the degree of rotation. The skull defect should not be repaired, but the child fitted with a plastic prosthesis incorporating a wig. R. J. Brrreton

Sturge-Weber cranial






R. D. Home. 435, 1976.

E. Bottshouser, J. Wilson, J Neural Neurosurg Psych&r 39:429-

This is a less common form of the SturgeWeber syndrome than the one with unilateral calcification. The authors report 4 cases, bringing the total recorded to 21. The calcification is not present at birth, but EMI scan may demonstrate calcification before it is detectable by other means. The head circumference and EEG in early infancy are not good prognostic measurements since microcephaly and mental deterioration develop later. Nearly all cases have epilepsy and some degree of mental subnormality. The recently described cases had evidence of cortical blindness. The authors think that neurosurgery is contraindicated in these bilateral cases. -R. J. Brew/on Brain



and Mortality

Subdural and

Empyema. Results


Factors Various

Surgical Techniques. H. A. M. ven Alphen, and J. J. R. Dreissen. J Neural Neurosurg Psych&r 39:48 l-490, 1976.

In a review of 100 cases (82 intracerebral abscesses and 18 subdural collections of pus). the authors warn of the dangers of lumbar puncture in the diagnosis of meningitis which may have arisen from a ruptured brain abscess. Aspiration is condemned. as it may cause collapse of the abscess cavity and multiloculation, spreading infection increasing brain and damage. “Fractional drainage” by an indwelling catheter sited by the use of contrast medium and x-rays is their recommended form of management. This treatment compares favorably with surgical excision and has less morbidity. The overall mortality in acute cases was cases. Occipital 56”,,. and 32”, in subacute lobe abscesses and muitiple abscesses have a poor prognosis. but those following corn

pound skull fracture do better. Postabscess epilepsy occurred in only 3”,, -~-R. J. Brerc!on Cerebral Richardson,



A. Mohandos,






Argumogosamy. J Neural Neurosurg Psych&r 39:330-337, 1976. The cerebral manifestations were first reported in the U.S.A. in 1916 and later recognized in the tropics. The authors report 30 cases, aged 656 yr (mean 23 yr). previously in good health. They presented with a variety of neurologic symptoms and one-third had pulmonary lesions on radiography. The diagnosis was mostly made by the examination of CSF stained with India ink. Twenty-seven patients had evidence of meningitis, and 17 communicating hydrocephalus. In the latter, the mental state usually improved dramatically following insertion of a shunt; failure to do so implied the presence of multiple intracerebral cysts. Specific treatment was with the 5 fluorocytosine 200 mg/kg body weight/day, the drug penetrating the blood ~brain barrier well. The mortality rate was 43”,.- R. J. Brererun







Malignant Surgical

late Results. U. G. Stouffer and 2 Kinderchir 20(3):237-245. 1977.

Tumors Excision

in and

H. J. Pliiss.

One hundred thirty-five children with malignant solid tumors were treated at the Surgical Department of the University Children’s Hospital in Zurich between 1960 and 1974. Sixteen of these children underwent l- 3 thoracotomtes for lung metastases. One to 16 lung metastases were surgically excised. Of these 16 children, 9 had Wilms’ tumor. 3 osteosarcoma. I malignant teratoma of the testis, 1 malignant neurinoma, I malignant synovioma, and 1 undifferentiated sarcoma of unknown origin. Three children with Wilms’ tumors and the child with malignant teratoma of the testis survived 3-14 yr after thoracotomy. In 2 of these 4 children, the follow-up is now 12 and 14 yr, respectively. The other 12 children died, 8 within less than 12 mo, 4 1 4 yr after thoracotomy. The indication for surgical treatment of lung metastases in malignant tumors in childhood and its limits are discussed in the tight of the experience with these cases. -Karl-Ludwig Waag Continuous in


Regional Oncology.

Intro-arterial 1.