Separation of craniopagus conjoined twins: an evolution in thought

Advances in medicine have enabled more craniopagus twins to survive separation, but the ultimate goal, to have both twins emerge from their separation with full neurologic function and a chance at leading independent and productive lives, remains elusive. The authors were contacted to evaluate craniopagus conjoined male infant twins for separation. Once it was determined that the brains were separate, they reviewed the literature and elected to design an open-ended multistaged separation. Four major stages over 9 and a half months led to the successful separation and preservation of neurologic function. To the authors' knowledge, this is the first such outcome in such a case. This article reviews the pertinent literature and discusses the authors' rationale and methodology.