Visualization of Brain Vessel Connection of Siamese Twins
SOMATOM Definition Dual Energy Scanning
Author: Anirudh Kohli, MD Department of Radiology, Breach Candy Hospital Trust, Mumbai, India
Two children, 3-year-old female twins, fused at the cranium since birth (craniophagus), were transferred to the department of radiology for preparation for separation. For the pre-operative diagnosis and surgery planning, a CT-Angiography was performed to evaluate the vascular communications between the connected brain tissues of both children. The dissection of these communications was the key challenge for the separation procedure. In preparation for the CT scan and for brain vessel visualization, twin one was injected before twin two and finally, both were injected simultaneously.
The CT imaging revealed both venous communications as well as arterial connections. The arterial communications were well visualized in the superficial cranial branches of the external carotid. The superficial temporal and frontal artery of twin one and the superficial temporal and occipital artery of twin two were found to be communicating. This brain vessel anomaly was recognized to be the reason for volume overload in the brain tissue of twin two, thus resulting in hypertensity.
The results of the CT imaging provided excellent orientation for the surgical team to prepare a safe separation of the twins. A CT-Angiography was selected over an MR-Angiography due to the very short scan time required. This allowed a short sedation time, lowering the sedation risks for the children while concurrently delivering excellent image quality. With Dual Energy CT-Angiography, small vascular communications could be visualized that are critical in a pre-operational workup. This information is important to know exactly – before starting a surgery of this difficulty and severity.
Fig 3A and 3B: MIP visualization of vessel connection: in-flow of contrast media into the arteries of twin one (Fig. 3A) with drainage via the venous vessel system of twin two (Fig. 3A) and vice versa in a second CT-scan afterwards (Fig. 3B).
Examination Sequence Protocol
Reconstructed slice thickness
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