A conjoined twin is an uncommon congenital condition that has a very high morbidity and mortality prevalence. Identical twins united in utero are known as conjoined twins. It\'s an uncommon occurrence that poses a special difficulty for paediatric surgeons and obstetricians. Conjoined twins are a complicated by-product of monozygotic twinning, which raises the risk of death in the womb. One of the more prevalent varieties of conjoined twins is the thoraco-omphalopagus type, in which the heart is involved in an anterior, chest-based fusion. This case involves a 26-year-old woman who was diagnosed at 19 weeks with conjoined thoraco-omphalopagus twins using ultrasonography.

How embryos are cultured, in groups or individually, can influence their development and have other unforeseen impacts on subsequent assisted reproductive technologies. Although a group culture of embryos improves the blastocyst formation rates, this can create conditions wherein separate blastocysts may fuse. This fusion of 2 blastocysts can create unique logistic issues for embryo biopsy and genetic analysis. New culture approaches have emerged to facilitate individual embryo culture without losing the benefit of the group culture approach. Unique culture dishes and adjustments of laboratory culture/embryo handling protocols offer possible solutions to minimize or avoid blastocyst fusion.

Atypical twinning highlights that complex mechanisms responsible for twinning are not fully understood and may give further insight into the mechanisms involved. To assume that phenotypic difference is the result of dizygotic twinning would be erroneous and could have significant implications in the care and counseling provided to these patients.

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Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.

Craniopagus-type conjoined twins (joined at the head) are exceedingly rare. Separation of craniopagus conjoined twins is a challenging task mainly owing to complex vascular anatomy and limited experience with this disorder. Modern neuroimaging techniques including digital subtraction angiography can be used to preoperatively assess the cerebral vascular system. These techniques can also provide the raw data to fabricate three-dimensional true-scale models. We report a case in which endovascular techniques have been used in the separation of craniopagus conjoined twins. To our knowledge there are no reports of successful incorporation of neurointerventional methods in the disconnection of shared venous channels.

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