Background - Craniopagus twinning is an extremely rare congenital malformation which usually involves complex vascular connections and can lead to poor surgical outcomes. Preoperative planning and surgical separation of craniopagus are challenging tasks to physicians. Newer neurosurgical and endovascular techniques with the aid of recent advances in medical imaging (computed tomography, magnetic resonance imaging and digital subtraction angiography) have contributed to very few reported successful cases of separation.
Case - We present a case of 9 month old craniopagus twins for preoperative evaluation. A four-vessel angiography demonstrated a shared superior sagittal sinus.
Conclusion - For cases of craniopagus, accurate anatomic imaging, a comprehensive planning and preparation, neuroendovascular techniques and multidisciplinary approach are of utmost importance to achieve a successful separation.