危地马拉连头双胞胎的分离手术。
The separation of Guatemalan craniopagus twins.
作者信息
Frazee John, Fried Itzhak, Kawamoto Henry, Lazareff Jorge, Nieto Jaime, Patel Swati, Urata Mark, van de Wiele Barbara
机构信息
Division of Neurosurgery, UCLA David Geffen School of Medicine, PO Box 957039, Los Angeles, CA 90095-7039, USA.
出版信息
Childs Nerv Syst. 2004 Aug;20(8-9):593-600. doi: 10.1007/s00381-004-0979-2. Epub 2004 Jul 17.
CASE REPORT
The particularities of the surgical procedure for the separation of craniopagi twins performed at UCLA in 2002 are presented. The main difficulty for the neurosurgeons was that the twins shared a common sagittal sinus and that one of the sisters had a poorly developed collateral venous system, thus anticipating a set of postoperative clinical problems. During surgery, the response of the brain to the progressive occlusion of the venous bridges was monitored with EEG and Doppler ultrasound. One of the sisters had a large intracerebral hematoma that was evacuated and later developed hydrocephalus, which was treated with a ventriculoperitoneal shunt.
OUTCOME
One of the sisters had a basically uneventful recovery while the other contracted E. coli meningitis 8 months after surgery, thus impairing her motor and cognitive development.
DISCUSSION
The details and intricacies of the anesthesia and plastic surgery are also outlined.
病例报告
介绍了2002年在加州大学洛杉矶分校进行的颅联体双胞胎分离手术的特殊性。神经外科医生面临的主要困难是这对双胞胎共用一条矢状窦，且其中一个姐妹的侧支静脉系统发育不良，因此预计会出现一系列术后临床问题。手术过程中，通过脑电图和多普勒超声监测大脑对静脉桥逐渐闭塞的反应。其中一个姐妹出现了一个大的脑内血肿，进行了血肿清除，后来又发展为脑积水，通过脑室腹腔分流术进行了治疗。
结果
其中一个姐妹基本康复顺利，而另一个在术后8个月感染了大肠杆菌性脑膜炎，从而损害了她的运动和认知发育。
讨论
还概述了麻醉和整形手术的细节与复杂性。
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