Separation of Craniopagus (head-joined) Conjoined Twins

Craniopagus twins are a very rare type of conjoined twins who are joined at the head when born. This condition happens in about 0.6 out of every 1 million births and can be very dangerous. Life before surgery for these twins can be difficult because they share skull bones and sometimes important blood vessels, which can cause serious health problems. “The presence of a shared superior sagittal sinus is the most critical aspect of the fusion because it will affect surgical planning and the chance of achieving a successful separation” (Flanders et al). 

The separation of Craniopagus twins is one of the most challenging surgeries in medicine. Surgeons use careful planning and modern technology to increase the chances of success. For example, teams use 3-dimensional computer models and printed models to practice and plan the operation. Special devices called tissue expanders and external distractors slowly stretch the skin, skull, and blood vessels, while using navigation tools to avoid damaging the brain. An extremely successful surgery and good post-operative care can allow patients to leave the general ward within a few days with no neurological deficit. 

After surgery, the twins can live independent lives with much better health, safety, and freedom to remain independent from each other. Early separation is helpful because young brains can recover more quickly from surgery. “These techniques allowed for separation of the twins at an early age and harnessed the regenerative capacity of their young brains” (Flanders et al). The surgery allows the twins to develop normally, play, and interact without being physically connected. Modern techniques such as computer-aided modelling, distracting devices, and careful monitoring have made it possible to save the lives of twins who would otherwise face major risks. Overall, this surgery shows how teamwork, technology, and medical skills can overcome one of the rarest and most difficult birth defects in the world.

Written by Malak Ibrahim at Incisionary

APA References

Curry, A. (n.d.). [Image]. NBC News. Retrieved August 14, 2025, from https://www.nbcnews.com/id/wbna9483659

Kheir, A. E. M. (2016). Craniopagus twins: Challenges and surgical separation. PMC. Retrieved August 14, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC4949905/

Flanders, S. A., et al. (2018). Clinical trial of the first-in-human heart xenotransplantation. The New England Journal of Medicine. Retrieved August 14, 2025, from https://www.nejm.org/doi/full/10.1056/NEJMoa1805132