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Back to 2014 Annual Meeting Abstracts
Conjoined Twin Separation: Integration of Three-Dimensional Modeling for Optimization of Surgical Planning
Sarah R. Sher, MD, Benjamin C. Wood, MD, Albert K. Oh, MD, Tina M. Sauerhammer, MD, Carolyn Cochenour, Gary F. Rogers, MD, JD, MBA, MPH, Michael J. Boyajian, MD.
Children's National Medical Center, Washington, DC, USA.
Background: Conjoined twins represent a rare anomaly of monozygotic twinning with an incidence of approximately 1 in 100,000 births. Although there is a high rate of perinatal mortality, conjoined twins who survive to surgical candidacy pose complex reconstructive challenges, unique to the location and extent of the union. While the diagnostic role of prenatal imaging has been established, there is a paucity of literature regarding the use of advanced imaging applications in planning surgical approach, as has been well described for other fields, such as orthognathic surgery. We describe our ten-year experience with conjoined twin separation, and the evolution of medical modeling and three-dimensional (3D) imaging as a critical tool for pre-surgical planning.
Methods: We performed a retrospective review of all consecutive cases of conjoined twin separation at a single institution from January 2004 to December 2013. Data were collected related to patient demographics, co-morbidities, surgical details, perioperative complications, survival, long term outcomes, and type of medical modeling system used for preoperative planning.
Results: Five sets of conjoined twins underwent separation during the ten year study period. There were three sets of thoraco-omphalopagus twins, one set of pyopagus twins, and one set of ischiopagus tetrapus twins. The mean age of separation was 70 days, with a mean of 3.5 surgical procedures performed per patient during the first year of life. One set of twins experienced post-separation complications, which warranted immediate return to the operating room. The overall survival rate after separation was 80%. The imaging methods used were computed tomography with 3D reconstruction, plaster molds, 3D modeling with composite printing, and virtual surgical planning.
Conclusion: Our series of conjoined twin separation represents the highest survival rate reported in the literature. The use of medical modeling in pre-surgical planning has proven to be a key element in optimizing the outcomes for patients with this rare anomaly. Recent advances in three-dimensional imaging have further extended those capabilities to facilitate virtual interactive modeling and surgical simulation to predict outcomes of specific techniques including tissue expansion and local tissue transfer.
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