A Contemporary Approach to Craniopagus Separation

The authors present their successful approach to the cranial separation and reconstruction of twins with partial angular craniopagus. At 6 months old, a single, custom-designed, wedge-shaped tissue expander was placed. This expander leveraged unique craniopagus anatomy: it expanded against a thick, rigid strip of bone at the cranial connection between the twins. This allowed for high-volume scalp expansion against a stable bony base. Once expanded, novel virtual and physical soft tissue modelling methods were used to both verify adequate scalp expansion and plan the incision lines and flap designs. At 10 months old, the infants underwent single-stage cranial separation and successful soft tissue closure using only native expanded scalp.