Dr. Ken Winston – Surgical Separation Protocol Pioneer

from Practice Update, Fall 2004

Ken R. Winston, MD, Pediatric Neurosurgeon on staff at The Children’s Hospital and Professor of Neurosurgery at UCHSC pioneered the protocol used for the surgical separation of craniopagus(conjoined at the head) twins.

Dr. Winston developed a classification system for separation of craniopagus twins in 1987. Previously, classification was based on relative facial orientation and had little relevance to predicting survival or communicating important anatomical relations. Dr. Winston proposed classifying of craniopagi by the portions of the crania that are connected. Classification by type of junction conveys much more useful anatomical information about the union and can predict the expected difficulty in separation.

Craniopagi are classified by Type A, B, C or D. Those craniopagi connected by scalp and subcutaneous tissues, perhaps with bony fusion, are designated as Type A; craniopagi who share dura matter, but not leptomeninges or brain are Type B; those who share leptomeninges as Type C; and those who have a structurally continuous central nervous system as Type D. Types C and D are considerably more complex and dangerous, particularly type D. The feature that makes these separations difficult is the venous anatomy. By classifying craniopagi by type of junction and location, venous anatomy can be predicted with more confidence.

As technology and expertise results in more and more successful separations of craniopagus twins – such as the separation of the Filipino conjoined twins this summer at New York 's Montefiore Medical Center – the classification system developed by Dr. Winston will continue to influence  both the successful separation and projected improved outcomes for these children.

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