How I Do It: Unveiling the Imaging Spectrum of Craniopagus Twins Using Multiparametric Assessment

Area of Science:

• Medical Imaging
• Pediatric Surgery
• Radiology

Background:

• Craniopagus twins present significant surgical challenges with high morbidity and mortality.
• Inadequate preoperative planning is linked to suboptimal outcomes, with survival rates around 60%.

Purpose of the Study:

• To present a systematic, multiparametric radiologic approach for presurgical planning in craniopagus twins.
• To guide radiologists and surgeons in managing these complex cases.

Main Methods:

• Utilized CT angiography/venography, MRI/MR angiography, and conventional angiography.
• Incorporated virtual and/or augmented reality for enhanced visualization.
• Examined bone, dura, shared vessels, and brain parenchyma in 15 sets of twins.

Main Results:

• Detailed multiparametric radiologic analysis is crucial for understanding complex anatomy.
• A systematic approach aids in stratifying risk and planning multistaged separations.
• Identified critical anatomic challenges for surgical teams.

Conclusions:

• Comprehensive radiologic assessment is imperative for successful craniopagus twin separation.
• This systematic approach, utilizing advanced imaging and VR/AR, improves surgical planning and outcomes.
• The study provides a valuable guide for managing these rare conjoined twin cases.