Separation of Craniopagus Twins by a Multidisciplinary Team

New England Journal of Medicine

January 24, 2019
Gregory G. Heuer, M.D., Ph.D., Peter J. Madsen, M.D., Tracy M. Flanders, M.D., Benjamin C. Kennedy, M.D., Phillip B. Storm, M.D., and Jesse A. Taylor, M.D.


Conjoined twins who are classified as craniopagus (joined at the cranium) have a rare congenital anomaly. Despite advances in surgical techniques and critical care, the rate of complications and death is still high among twins with total fusion in which the superior sagittal sinus is shared. Here, we describe total-fusion craniopagus twins who at 10 months of age underwent successful surgical separation performed by a multidisciplinary team. Computer-aided design and modeling with a three-dimensional printer, custom-designed cranial distraction and constriction devices, and intraoperative navigation techniques were used. These techniques allowed for separation of the twins at an early age and harnessed the regenerative capacity of their young brains.