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Separating craniopagus twins

Lucina doesn’t normally feature surgical case reports, but this one reported in the NEJM is remarkable (Heuer G et al doi:10.1056/NEJMoa1805132). A highly-skilled team from the Children’s Hospital of Philadelphia successfully separated conjoined twin girls, who shared skull bones and a common sagittal sinus, but not brain tissue. They were delivered at 30 weeks, and pre-operatively required tissue expansion techniques over several months to make separation easier. Meticulous planning, which involved computerised modelling and 3-D printing, led to an 11 hours separation procedure at age 10 months. Remodelling the venous sinuses was a particular challenge. The girls have done well, with intact skulls and only mild neurocognitive deficits. Conjoined twins are rare and craniopagus even rarer, so each case has to be looked at afresh as new technologies emerge.

Figure 1

Craniopagus twins at birth, and post-separation.

EMLA in infants

‘Magic cream’, or topical local anaesthetic …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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