A rare case of craniopagus parasiticus delivered vaginally at a district hospital

Craniopagus Parasiticus is a very rare type of parasitic twinning. It has an incidence of only 4-6/10,00,000 births. Most of the babies with Craniopagus Parasiticus are still born with only few cases which survived after postpartum surgical separation. In Craniopagus Parasiticus the head of one of the twins is parasitic and protrudes from the head of the normal twin with an undeveloped or underdeveloped body. The skulls of the twins are fused but the body of one of the twins is not developed. The developed twin is known as the auto site while the undeveloped twin is the parasite. Age of the mother or certain nutritional factors have been implicated in the etiology of this type of twinning. This is a rare case report of a female baby with a parasitic craniopagus delivered vaginally at this district hospital. The patient was a fourth gravida 28 year old. There was antenatal polyhydramnios. The patient delivered preterm a still born female baby with a parasitic co-twin. In this case the heads of the twins were fused in temporal and parietal areas while the body of the parasitic twin was completely undeveloped. It was a morphologically female baby with rudimentary labia. The causes of Craniopagus Parasiticus are still not known. Scientists and researchers are continuing work to determine these and also to improve the prognosis and chances of post-surgical survival of these twins. Till present day however there have been only limited number of studies on Craniopagus Parasiticus owing to the rarity of the cases.

Successful Separation Of Craniopagus Parasiticus

OBJECTIVE Craniopagus parasiticus is an extremely rare condition. The first attempt to separate such twins was performed in the Dominican Republic in 2004. The infant died 7 hours after surgery. The aim of this report is to present a case in which surgical separation was successfully performed on February 18, 2005. In February 2006, the child was still alive and in relatively good health. METHODS The authors operated on a patient with craniopagus parasiticus at Benha Pediatric Hospital in Egypt, 45 km north of Cairo. The child was 10 months old when the surgery was performed. By minimizing the time of surgery and adequate control of intraoperative bleeding, a successful surgical separation was achieved. Computed tomography, magnetic resonance imaging, magnetic resonance angiography, and computed tomographic angiography provided the information necessary to perform surgery. RESULTS The child underwent operation at the age of 10 months; the duration of surgery was 9 hours. Bleeding was the most serious problem, with the child receiving four liters of blood. The main arterial supply to the parasite was via the middle cerebral artery and was ligated in the Sylvian fissure. Bleeding, however, was mostly venous and was mainly controlled by diathermy and thrombin soaked packs of Surgicel, as well as clipping. After separation of the parasitic head, the dura was repaired using artificial dural grafts. Free bone flaps from the parasite were used to cover the osseous defect in the autosite. Skin flaps from the parasite were also used to cover the cranium. CONCLUSION This is the second case of craniopagus parasiticus in which separation was attempted. The first patient, operated on in the Dominican Republic, died 7 hours after surgery. In the present case, the child is still alive and without neurological deficit.