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Kelly Siberine Lori and Reba Schnapell Krista and Tatiana Hogan Clarence and Carl Agurirre (seperated craniopagus conjoined twins) “OMG!! Absolutely fantastic. Unbelievable. Unprecedented as far as I know.” -Todd Feinberg, professor of clinical psychiatry and neurology at Albert Einstein College of Medicine “ridiculously compelling.” neuroscientist in Kelowna Conjoined Twins • Identical twins joined in utero • As known as Siamese twins • Occurrence ranges from 1 in 50,000 births to 1 in 100,000 births • Survival rate: 25% • 40 sets born in the United States each year • Share a single common chorion, placenta, and amniotic sac (characteristics not exclusive to conjoined twins) Fission vs. Fusion • 2 contradicting theories: – Fission: fertilized egg splits partially – Fusion: fertilized egg completely seperates, but stem cells (looking for similar cells) find like-stem cells on the other twin and fuse together How They Become Conjoined • Embryo starts to divide but does not complete the process • Area where the embryo stop dividing is where the twins become one • Malformation believed to occur first 13th & 15th days after separation • Inner mass of cell split into equal halves (each capable of forming an individual) • Complete separation of inner cell mass of chronic vesicle doesn’t occur + non-separated areas remained fused through development • In normal embryo and fetus development, every cell knows where it is in the body due to chemical messages • If confused, conjoined twins don’t work normally and form a single organism w/ 2 heads, 2 hearts, & 4 legs/arms Types of Conjoined Twins MOST COMMON • Thoraco-omphalopagus • Thoracopagus • Omphalopagus • Parasitic twins • Craniopagus LESS COMMON • Cephalopagus • Synecephalus • Cephalothoracopagus • Xiphopagus • Ischiopagus • Omphalo-Ischiopagus • Parapagus • Craniopagus parasiticus • Pygopagus (Iliopagus) Thoraco-omphalopagus • 28% of cases • Two bodies fused from the upper chest to the lower chest • usually share a heart • may also share the liver or part of the digestive system Thoracopagus • 18.5% of cases • Two bodies fused from the upper thorax to lower belly • Heart always involved • Seperation rarely attempted Omphalopagus • 10% of cases • Two bodies fused at the lower chest • Heart is never involved • Often share a liver, digestive system, diaphragm, and other organs • Highest success rate for seperation Parasitic Twins • 10% of cases • Twins that are asymmetrically conjoined • One twin is small and, less formed, and dependent and the larger twin for survival Craniopagus • 6% of cases • Fused skulls, but separate bodies • Conjoined at the back of the head, front of the head, or side of the head • Not conjoined on the face or base of the skull • Seperation possible depending on amount of shared brian, but extremely risky • Krista and Tatiana Hogan Seperation • Surgery can range from simple to extremely complex • Usually results in the death of one or both of the twins • Success Rates – twins joined at the base of the spine: 68% chance of successful separation – twins with conjoined hearts at the ventricular: no known survivors – 50% in general Greatest Risks • Anesthesia and surgical complications greatest risk during and after surgery • Complications include: – Blood clots in newly constructed blood vessels – Intracranial bleeding – Heart complications – infections •Critical period: 3-4 days after surgery