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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 961-967, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Separation of craniopagus Siamese twins using cardiopulmonary bypass and hypothermic circulatory arrest

DE Cameron, BA Reitz, BS Carson, DM Long, CR Dufresne, CA Vander Kolk, LG Maxwell, DM Tilghman, DG Nichols and RC Wetzel
Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Md.

Occipitally joined craniopagus Siamese twins were separated with the use of cardiopulmonary bypass and hypothermic circulatory arrest. The 7- month-old infants shared a large sagittal venous sinus that precluded conventional neurosurgical approach because of risk of exsanguination and air embolism. After craniotomy and preliminary exposure of the sinus, each twin underwent sternotomy and total cardiopulmonary bypass with deep hypothermia. Hypothermic circulatory arrest allowed safe division and subsequent reconstruction of the sinus remnants. Several unusual problems were encountered, including transfusion of a large blood volume from one extracorporeal circuit to the other through the common venous sinus, deleterious warming of the exposed brain during circulatory arrest, and thrombosis of both pump oxygenators. Both infants survived, although recovery was complicated in each by neurologic injury, cranial wound infection, and hydrocephalus. This case demonstrates the valuable supportive role of cardiopulmonary bypass and hypothermic circulatory arrest in the management of complex surgical problems of otherwise inoperable patients.

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