The Doctors That Carried Out One Of The World’s Rarest Surgeries..

For the first time, Abby and Erin Delaney can finally sleep in separate beds.

The 10-month old twins from North Carolina were born connected and conjoined at the head, a very rare condition indeed.

After months of planning and preparation, the two endured a successful yet timely separation surgery that lasted around 11 hours almost a week ago at the children’s Hospital of Philadelphia in south-eastern Pennsylvania.

“Separating conjoined twins is a very complex surgery followed by a long and complicated recovery, but we are very hopeful for a positive outcome,” commented Jesse Taylor, the plastic surgeon who co-led the surgery alongside neurosurgeon Gregory Heuer.

“Erin and Abby are now recovering in our Paediatric Intensive Care Unit under close monitoring by our expert teams.”

What happens with identical twins is that an embryo is splitted into two, earlier into the pregnancy. But with the conjoined twins, the embryo struggles to separate all the way, resulting in remaining connected.

Conjoined twins are a rare result in pregnancy, occurring once in about every 200,000 births.  As for craniopagus twins, those that are connected to head, one of the rarest forms of conjoined twins. Accounting to around 2% of conjoined twins in general.

Severity can be measured on how and where the conjoined twins are connected.  and according to one expert,  most craniopagus twins don’t stand a chance for survival.

Riley and Heather Delaney, the parents of twins, had learnt that the girls were conjoined earlier last year, in around 11 weeks during pregnancy.

At the time it was too soon to know whether the twins would be able to be separated, the mother insisted in travelling from North Carolina to Pennsylvania for a prenatal care.

Eventually, she was moved into a hospital in Philadelphia that specifically focused on mothers that carried babies with complex congenital conditions.

On July 24, 2016, Abby and Erin were delivered 10 weeks prematurely by C-section, with each baby weighing about 2 pounds.

Resilient Doctors worked on a comprehensive plan to separate the twins.

The chief of paediatric neurosurgery, Alan R. Cohen at Johns Hopkins Hospital didn’t want to make a comment on the twin’s case. However he did say that “separating craniopagus twins can be high-risk surgery.”

He also said that surgeries are done at major medical centres where teams of neurosurgeons, plastic surgeons, anesthesiologists and critical care physicians spend months upon months studying patient’s brain scans and in some cases 3-D models to try and come up with a safe and successful disconnections.

“Depending on where the heads are joined and how much they are fused, that determines the complexity of the operation,” Cohen said.

He went on saying that the most feared complication of the surgery is how to manage the shared blood vessels – in particular the veins that drain the brain – since it’s common that one of the twins receive the good veins and the other unfortunately doesn’t.

Like any surgery,  there is also ethical considerations to bear in mind. The twins may not survive the intervention, or it might be that one of the twins survives and the other doesn’t or is in a poor neurological condition.

Success here means that the surgeons are able to separate the twins, but in terms of the bigger picture, theres usually a long road ahead for the family and the medical team involved.

Someone had posted on a Facebook page set up for the twins a night before the surgery on June 6 and said:

The girls have a big procedure tomorrow. We ask for as many prayers as you can spare. It will be a long day for us.

Posted by Delaney Twins on Monday, June 5, 2017

Please bear with us. I'm not able to update yet. Just keep praying for us. Your prayers are felt and needed.

Posted by Delaney Twins on Friday, June 9, 2017

 

The Children’s Hospital of Philadelphia reported that around 30 doctors nurses and other medical professionals worked attentively to separate the twins – a first for the hospital.

The hospital has separated 22 conjoined twins in the past but never a pair of craniopagus twins.

The surgery itself, was meticulously carried out: surgical equipment was colour-coded with green and purple tape – each colour assigned to each twin. The medical team focused on one body – and once the girls were separated – they split care for the two.

“During the separation surgery, our team first meticulously separated the infants’ shared blood vessels and dura, the tough protective membrane surrounding both brains, then moved on to separate the sagittal sinus, the most difficult portion of the operation,”  commented Heuer, the neurosurgeon.

“Finally, we divided our team into two halves, one for each of the girls, and finished the reconstruction portion of the surgery.”

The twins are reported to have additional surgeries but the hospital plans to send them home later this year.

“When we go home, it’s going to be a big party,” Heather Delaney joyfully expressed in a statement from the hospital. “Welcome home, baby shower, first birthday.”

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