Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Craniopagus twinning is a rare embryological event occurring in 1 in 2.5 million births. ⋯ The separation of craniopagus twins demands a multidisciplinary team approach. Utilizing preoperative neuroendovascular techniques to occlude shared vascular anastomotic channels, complex total vertical craniopagus twins can now be successfully separated in a one-stage procedure.
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We present the case of 2-year-old craniopagus twins who are in the process of undergoing a staged separation of their craniums. In addition, they will undergo a full calvarial vault remodeling to reconstruct the lacking skull and scalp tissue in each child. We elected to do a staged separation rather than a single marathon operation for various reasons, which we will detail in this report. ⋯ Successful separation of viable conjoined twins has been historically a great rarity. Successful separation of twins where both have come out of surgery without any neurological deficit remains a rare occurrence and in our mind the ultimate goal.
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Anaesthesia for conjoined twin surgery, whether prior to or for separation, is an enormous challenge to the paediatric anaesthesiologist. ⋯ The site and complexity of the conjunction will affect airway management, acquisition of vascular access, the extent of blood loss, and the number of surgical specialties involved. Preoperative assessment and planning, with interdisciplinary communication and cooperation, is vital to the success of the operations. These twins require a dedicated team of anaesthetists for each child, and, consequently, duplication of all monitoring and equipment in one operating room is necessary. Meticulous attention to detail, monitoring, and vigilance are mandatory. Planning for the postoperative period in the intensive care unit (ICU), as well as the babies' reconstruction and rehabilitation, is essential from the time of the initial admission.
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Comparative Study Clinical Trial
Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis.
The current study was performed to determine the rate of allogeneic blood transfusion for coronal and metopic craniosynostosis surgery done by two experienced pediatric neurosurgeons and to identify factors associated with a need for transfusion. ⋯ Low transfusion rates were achieved in primary operations for coronal and metopic craniosynostosis using simple intraoperative techniques and by accepting a low postoperative hemoglobin level.
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Repair of myelomeningoceles larger than 5 cm in diameter is not easy. We describe a simple technique. ⋯ This simple technique is appropriate for the closure of large myelomeningoceles and does not need more extensive and complex procedures.