Conjoined twins: implications for blastogenesis

It is difficult to draw sweeping general conclusions about the blastogenesis of CT, principally because so few thoroughly studied cases are reported. It is to be hoped that methods such as painstaking gross or electronic dissection will increase the number of well-documented cases. Nevertheless, the following conclusions can be proposed: 1. Most CT can be classified into a few main anatomic types (or paradigms), and there are also rare transitional types that show gradation between the main types. 2. Most CT have two full notochordal axes (Fig. 5); the ventral organs induced along these axes may be severely disorientated, malformed, or aplastic in the process of being arranged within one body. Reported anatomic types of CT represent those notochordal arrangements that are compatible with reasonably complete embryogenesis. New ventro-lateral axes are formed in many types of CT because of space constriction in the ventral zones. The new structures represent areas of "mutual recognition and organization" rather than "fusion" (Fig. 17). 3. Orientations of the pairs of axes in the embryonic disc can be deduced from the resulting anatomy. Except for dicephalus, the axes are not side by side. Notochords are usually "end-on" or ventro-ventral in orientation (Fig. 5). 4. A single gastrulation event or only partial duplicated gastrulation event seems to occur in dicephalics, despite a full double notochord. 5. The anatomy of diprosopus requires further clarification, particularly in cases with complete crania rather than anencephaly-equivalent. Diprosopus CT offer the best opportunity to study the effects of true forking of the notochord, if this actually occurs. 6. In cephalothoracopagus, thoracopagus, and ischiopagus, remarkably complete new body forms are constructed at right angles to the notochordal axes. The extent of expression of viscera in these types depends on the degree of noncongruity of their ventro-ventral axes (Figs. 4, 11, 15b). 7. Some organs and tissues fail to develop (interaction aplasia) because of conflicting migrational pathways or abnormal concentrations of morphogens in and around the neoaxes. 8. Where the cardiovascular system is discordantly expressed in dicephalus and thoracopagus twins, the right heart is more severely malformed, depending on the degree of interaction of the two embryonic septa transversa. 9. The septum transversum provides mesenchymal components to the heawrt and liver; the epithelial components (derived fro the foregut[s]) may vary in number from the number of mesenchymal septa transversa contributing to the liver of the CT embryo.(ABSTRACT TRUNCATED AT 400 WORDS)