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The Evolution Of 3D Technology In Conjoined Twin Surgery; Our Fifteen-year Experience Separating Twins Conjoined At The Head
Hayeem L. Rudy1, Jillian Schreiber, MD1, Nicole Wake, PhD1, Evan Garfein, MD1, Jayme A. Farina, Jr., MD2, Andy Christensen3, James T. Goodrich, MD, PhD1, Oren Tepper, MD1.
1Montefiore Medical Center, Bronx, NY, USA, 2University of Sao Paulo, Sao Paulo, Brazil, 3University of Ottawa, Ottawa, ON, Canada.

PURPOSE:
Craniopagus twins are the rarest form of conjoined twins, and separation poses a significant challenge to both neurological and plastic surgeons. Our group have been involved in separating 11 cases of craniopagus twins over a 15-year period. Three-dimensional technology has been central in the planning and execution of these operations. This study describes the evolving advantages of three-dimensional technology in the separation of craniopagus twins over a 15 year experience.
METHODS:
Our group has surgically separated eleven sets of craniopagus twins, and consulted on thirty-five cases in total, over the past 15 years (2004-2019). In each case, 3D technology was used for pre-operative planning, intra-operative execution, and post-operative analysis of outcomes. 3D imaging with CT/MRI scans, and 3D surface scanning, were used in all cases. We identified four cases from our experience that highlight critical landmarks in the evolution 3D technology.
RESULTS:
Applications of 3D technology have evolved over the past 15 years from reference 3D models alone to include virtual planning and 3D-printed surgical guides. In addition, 3D technology has expanded from virtual planning for skeletal elements for cranial vault remodeling to include soft tissue planning, such as placement of tissue expanders and design of scalp rotation flaps.
CONCLUSION: Successful separation of total craniopagus twins relies on meticulous pre-operative planning and execution. 3D technology offers anatomic reference and surgical guidance in the separation of total craniopagus twins. As 3D technology evolves, there are increasing applications to complex surgery involving both skeletal and soft tissue elements as demonstrated in by our experience.


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