Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins

A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1–2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.

James T. Goodrich, MD, PhD, 1946–2020: a historical perspective and his contributions to craniopagus separation

Dr. James Tait Goodrich was an internationally renowned pediatric neurosurgeon who pioneered the neurosurgical procedures for the multistage separation of craniopagus twins. As of March 2020, 59 craniopagus separations had been performed in the world, with Goodrich having performed 7 of these operations. He was the single most experienced surgeon in the field on this complex craniofacial disorder. Goodrich was a humble individual who rapidly rose through the ranks of academic neurosurgery, eventually serving as Director of the Division of Pediatric Neurosurgery at the Children’s Hospital at Montefiore Medical Center in the Bronx, New York. In this historical vignette, the authors provide context into the history of and sociocultural attitudes toward conjoined twins; the epidemiology and classification of craniopagus twins; the beginnings of surgery in craniopagus twins; Goodrich’s neurosurgical contributions toward advancing treatment for this complex craniofacial anomaly; and vignettes of Goodrich’s unique clinical cases that made mainstream news coverage.

Twins Reared Apart: Zygotic Division After Artificial Insemination/Twin Research Reviews: Selective Resuscitation of Premature Twins; Scientist Jailed for Editing Twins’ Genes; Sexual Arousal Patterns in MZ Twins Discordant for Sexual Orientation; MZ Twins With Jejuno-Ileal Atresia/Media Reports: Twin Girls’ Search for a Bone Marrow Donor; Puppy with a Possible Parasitic Twin; Twins in Silicon Valley; Surgical Separation of Craniopagus Twins; Twin-Based New Yorker Magazine Cartoon; Twin Tragedies

This article opens with the brief life histories of reared-apart monozygotic (MZ) male twins. A New York City program that helped childless couples conceive via artificial insemination from the 1930s to the 1950s is examined as it related to these twins. The frequency with which pregnancies following assisted reproductive technology resulted in MZ twin pairs is also provided. Next, summaries of twin research concerning selective resuscitation, gene editing, sexual arousal and jejuno-ileal atresia are presented. The article ends with media reports of twin girls’ efforts to find a bone marrow donor for their father, possible parasitic twinning in a puppy, identical female twins’ business venture, the surgical separation of craniopagus twins, a twin-themed magazine cartoon and tragic events involving identical male twins.