Conjoined twins are a rare occurrence resulting from the incomplete division of a single fertilized egg. Among the various types of conjoined twins, cephalothoracopagus is one of the least common forms. This condition involves the fusion of the heads and thoracic regions of two embryos, resulting in a shared cranial and thoracic structure. The term “cephalothoracopagus” comes from Greek: cephalo, meaning head, thoraco, meaning chest, and pagus, meaning fixed.[1] Conjoined twins occur in approximately 1 in 50,000 to 1 in 200,000 live births, with cephalothoracopagus representing one of the rarest subtypes.[4]
The detection of cephalothoracopagus twins is usually achieved through prenatal imaging. Ultrasonography is the primary diagnostic tool and can often identify the condition early in gestation.[1]
In reported cases, abnormalities were confirmed postnatally using clinical examination and computed tomography (CT) scans, providing a detailed view of the shared anatomy.[2] Early diagnosis is essential for planning delivery and preparing for potential medical interventions.
Anatomical studies indicate that cephalothoracopagus twins share a single head and thoracic cavity, while their upper and lower limbs remain separate, and although their lower abdominal and pelvic cavities are usually independent, the shared cranial and thoracic structures can create complex anatomical and physiological challenges.[3] However, the shared cranial and thoracic structures can create complex anatomical and physiological challenges, including the management of cardiovascular and respiratory function.[1]
Cephalothoracopagus twins present significant clinical challenges. Shared thoracic and cranial structures can affect heart and lung function, often requiring specialized surgical interventions. Managing such cases necessitates a multidisciplinary approach, involving obstetricians, pediatricians, radiologists, and surgeons to optimize outcomes.[3] However, cephalothoracopagus survival is extremely limited, with most cases resulting in stillbirth or early neonatal death. Ethical considerations, including the feasibility of surgical separation and the quality of life for surviving infants, remain central to clinical decision-making.[5]
Conclusion
Cephalothoracopagus twins are a rare and complex phenomenon in human development. Advancements in prenatal imaging have improved the ability to detect these anomalies early, enabling better planning and management. Despite these advancements, the rarity and complexity of this condition continue to challenge medical practitioners. Continued research, along with careful reporting of outcomes and ethical considerations, is vital for improving understanding and care strategies.
Chen, C. P., et al. "Prenatal diagnosis of cephalothoracopagus janicepsdisymmetros using three-dimensional power Dopplerultrasound and magnetic resonance imaging." Ultrasound Obstet Gynecol 2003; 22: 299–304.
Saravagi G, Chawla S, Bhagat HK, Sreedhar CM. Cephalothoracopagus: A rare conjoined twins, pre and postnatal findings. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S258-S261.
Cîrstoiu MM, Filipoiu FM, Brătilă E, Berceanu C, Cîrstoiu FC, Budu VA, Bulescu IA, Munteanu O. Morphological study of cephalothoracopagus deradelphus type conjoined twins. A case report. Rom J Morphol Embryol. 2016;57(1):249-52. PMID: 27151716.
Spencer, R. "Conjoined twins: Theoretical embryologic basis." Teratology 45, no. 6 (1992): 591–602.
Bondeson, J. "The Biddenden Maids: A curious chapter in the history of conjoined twins." Journal of the Royal Society of Medicine 85, no. 4 (1992): 217–221.
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