Plastic Surgery Research Council

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Applying State of the Art 3D Technology in the Separation of Craniopagus Twins
Hayeem L. Rudy, BA1, Brian D. Mikolasko, MD2, Katie Weimer, MA3, Carrie Stern, MD1, Evan Garfein, MD2, James T. Goodrich, MD, PhD4, Oren Tepper, MD2.
1Albert Einstein College of Medicine, Bronx, NY, USA, 2Montefiore Medical Center, Division of Plastic and Reconstructive Surgery, Bronx, NY, USA, 33D Systems Corporation, Rock Hill, SC, USA, 4Montefiore Medical Center, Division of Pediatric Neurosurgery, Bronx, NY, USA.

PURPOSE: Separation of craniopagus twins and reconstruction of subsequent soft and bony tissue defects necessitates comprehensive planning and precise execution to avoid associated high rates of morbidity and mortality. 3D technologies offer improved precision in surgical planning, intraoperative navigation, and post-operative assessment. This study reports the application of these technologies to the successful separation of a rare case of craniopagus twins.
METHODS:
Five-month-old male craniopagus twins underwent a four-staged separation. Three areas of 3D technology were utilized throughout all four stages: 3D-printed intraoperative anatomical reference models, 3D-printed intraoperative guides, and Virtual Surgical Planning (VSP). Anatomical data feeding into these technologies was generated from MRI, CT, and 3D stereophotogrammetry datasets.
RESULTS:
The twins were successfully separated and underwent scalp and calvarial reconstruction aided by (1) a soft tissue, skin envelope model, (2) clear skull models highlighting shared neurovasculature at each surgical stage, and (3) a single color-jet printed brain model. VSP was utilized to plan tissue expansion with surface area and volumetric analysis of the skin envelope using CAD-CAM files of tissue expanders. It also allowed optimal planning of skull reconstruction through simulation of post-operative results based on age-matched anatomical controls. Intraoperative jigs included (1) a complete circumferential osteotomy cutting guide and (2) skull cap templates to guide calvarial reconstruction.
CONCLUSION:
3D technologies played a key role in this successful separation of craniopagus twins. Incorporating these technologies into the planning and execution allowed for a level of precision and understanding of complex anatomy that has not been previously possible.


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