The use of uniform simulated models in the reconstruction of craniopagus twins.

: A unique approach to the planning of the separation and subsequent reconstruction of craniopagus twins is presented. In consultation with medical artists and prosthetists, exact models of our patients were fabricated preoperatively. Models were made of a hard acrylic to simulate bone and silicone rubber to simulate skin. In this fashion, the surgical teams were given an opportunity to preplan the bony separation of the heads, as well as to design the best possible coverage for reconstruction of the resulting defects. Physiological, mechanical, and aesthetic considerations are discussed. Two surgical delay procedures were performed without complication prior to neurosurgical separation. A broad segment of inextricably interconnected cerebellar tissue and a shared sagittal sinus could not be overcome at the time of final separation and proved to be fatal for both twins. Owing to the untimely deaths, we can only postulate that the delayed compound musculocutaneous flaps would have produced the best possible results and physiological protection for the extensive bony defects in both skulls resulting from this separation.