Related Experiment Video
Updated: Jul 18, 2026
Accessing the Porcine Brain via High-Speed Pneumatic Drill Craniectomy
Published on: July 5, 2024
Successful separation of craniopagus parasiticus
Mohamed Lotfy1, Sameh A Sakr, Basim M Ayoub
1Department of Neurosurgery, Cairo University, Cairo, Egypt.
Insights
Surgical separation of craniopagus parasiticus was successfully achieved in a 10-month-old infant, who survived and showed no neurological deficits. This marks a significant advancement in managing this rare conjoined twin condition.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Case Reports
Background:
- Craniopagus parasiticus is an extremely rare congenital condition involving conjoined twins sharing a skull.
- Previous surgical attempts at separation have had high mortality rates, with one documented case resulting in death shortly after surgery.
Purpose of the Study:
- To report a successful surgical separation of craniopagus parasiticus.
- To highlight advancements in surgical techniques and patient management for this rare condition.
Main Methods:
- A 10-month-old infant with craniopagus parasiticus underwent surgical separation.
- Advanced imaging (CT, MRI, MRA, CTA) was used for pre-operative planning.
- Minimizing surgical time and controlling intraoperative bleeding were key strategies.
Main Results:
- The 9-hour surgery involved significant blood loss, requiring four liters of transfusion.
- Arterial supply to the parasite was ligated, and venous bleeding was managed with diathermy and hemostatic agents.
- Dural and bone defects were repaired using grafts from the parasite, and skin flaps were used for closure.
Conclusions:
- This case represents the second surgical separation of craniopagus parasiticus and the first successful outcome.
- The patient survived the surgery and remained alive with no neurological deficits one year post-operation.
- Successful separation is achievable with meticulous surgical planning and execution.
Objective:
Craniopagus parasiticus is an extremely rare condition. The first attempt to separate such twins was performed in the Dominican Republic in 2004. The infant died 7 hours after surgery. The aim of this report is to present a case in which surgical separation was successfully performed on February 18, 2005. In February 2006, the child was still alive and in relatively good health.
Methods:
The authors operated on a patient with craniopagus parasiticus at Benha Pediatric Hospital in Egypt, 45 km north of Cairo. The child was 10 months old when the surgery was performed. By minimizing the time of surgery and adequate control of intraoperative bleeding, a successful surgical separation was achieved. Computed tomography, magnetic resonance imaging, magnetic resonance angiography, and computed tomographic angiography provided the information necessary to perform surgery.
Results:
The child underwent operation at the age of 10 months; the duration of surgery was 9 hours. Bleeding was the most serious problem, with the child receiving four liters of blood. The main arterial supply to the parasite was via the middle cerebral artery and was ligated in the Sylvian fissure. Bleeding, however, was mostly venous and was mainly controlled by diathermy and thrombin soaked packs of Surgicel, as well as clipping. After separation of the parasitic head, the dura was repaired using artificial dural grafts. Free bone flaps from the parasite were used to cover the osseous defect in the autosite. Skin flaps from the parasite were also used to cover the cranium.
Conclusion:
This is the second case of craniopagus parasiticus in which separation was attempted. The first patient, operated on in the Dominican Republic, died 7 hours after surgery. In the present case, the child is still alive and without neurological deficit.
