The separation of Guatemalan craniopagus twins

The particularities of the surgical procedure for the separation of craniopagi twins performed at UCLA in 2002 are presented. The main difficulty for the neurosurgeons was that the twins shared a common sagittal sinus and that one of the sisters had a poorly developed collateral venous system, thus anticipating a set of postoperative clinical problems. During surgery, the response of the brain to the progressive occlusion of the venous bridges was monitored with EEG and Doppler ultrasound. One of the sisters had a large intracerebral hematoma that was evacuated and later developed hydrocephalus, which was treated with a ventriculoperitoneal shunt. One of the sisters had a basically uneventful recovery while the other contracted E. coli meningitis 8 months after surgery, thus impairing her motor and cognitive development. The details and intricacies of the anesthesia and plastic surgery are also outlined.