Authors: Andrew J. Kobets, MD; Adam Ammar, MD; Rick Abbott, MD; James Goodrich, MD, PhD (Bronx, NY)

Introduction:

Craniopagus deformity is a rare congenital anomaly occurring in 1/1,700,000 live births. Early attempts at surgical resection in the 20th century have had poor outcomes, with one or both twins not surviving. With the development of staged surgical resection, as well as the advancement of 3D modeling techniques over the last 20 years, enormous improvements in surgical outcomes have occurred. This work reviews the advanced modeling and rendering techniques which have refined surgical separation of craniopagus twins and made outcomes safer.

Methods:

All cases of craniopagus twins evaluated and operated on by the senior author were reviewed with the associated 3D printed and virtual models. Early cases with only 2D traditional imaging studies were compared to newer cases in which advanced modeling was performed to determine to impact on surgical resection and planning.

Results:

Twenty eight cases were reviewed along with the advanced modeling used. There appeared to be four realms in which printed and virtual models played a substantial role in assisting preoperative planning. Namely, modeling was vital in determining the volume of potential tissue expansion required to correct postoperative skin defects, crucial for optimal intraoperative positioning and airway management, important to study brain interconnectivity and its relationship to surgical exposure, and finally immensely important to model venous anatomy in order to plan optimally-staged separation.

Conclusion:

The use of stereolithography and virtual planning has revolutionized how craniopagus anatomy is viewed and operative planning is undertaken. Planning for adequate skin coverage and brain and venous separation is no longer evaluated in real-time, nor does the surgeon have to rely on experience or ‘artistic’ interpretation to ensure the best outcomes for patients. This review of advanced imaging and printing technology has not been previous reported, and plays a unique role in the management of this rare deformity.