Role of biplane digital subtraction angiography, and 3D rotational angiography in craniopagus twins: A case report, detailed pictorial evaluation, and review of literature

Abstract

Cranially conjoined twins (craniopagus) are regarded as one of the rarest human malformations. Craniopagus represents 2 to 6% of conjoined twins and is the rarest type of disorder. A conventional angiogram with three dimensions is needed to confirm the exact extent of sharing of the arterial / venous tree. 3D angiography was first proposed by CORNELIUS and advanced into clinical practice by VOIGT in 1975. We present a case of craniopagus vertical type II twins, evaluated for cerebral circulation.

Keywords: 3D rotational angiogram; Craniopagus; digital subtraction angiogram.

Figure 1

Craniopagus vertical type II twins

Figure 2

Internal carotid angiogram showing normal arterial phase(A) and capillary phase (B)of the twin I

Figure 3

Showing the venous drainage of the twin I through the left transverse sigmoid system(arrow head) and circular sinus(arrow) into the twin II s transverse sigmoid jugular system bilaterally

Figure 4

Internal carotid angiogram showing the normal arterial(A) and capillary phases(B) of the twin II

Figure 5

Venous drainage is through the circular sinus(arrow) into Transverse - Sigmoid -Jugular system bilaterally and the occipital sinus. Deep Venous system is not identifi ed clearly

Figure 6

External carotid angiogram of twin II shows signifi cant cross over of ECA territory to supply Twin I scalp

Figure 7

Simulataneous and sequential injections of both the twins showing normal arterial and capillary phases

Figure 8

Venous drainage is through the circular sinus into Transverse - Sigmoid -Jugular system bilaterally and the occipital sinus.A signifi cant portion of the venous drainage is shunted into Twin I s left transverse sinus. Deep Venous system is not identifi ed clearly