Successful separation of conjoined craniopagus Sudanese twins

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Twin girls joined at the head, such that their major brain blood vessels were interconnected, have been safely separated. UK charity Facing the World played the central role in funding treatment, evaluating the children abroad, supporting the family and handling the logistics to bring Rital and Ritag Gaboura and their parents to London.

The Sudanese girls, whose condition is known as Craniopagus (joined at the head with fused skulls) required four complex operations at Great Ormond Street Hospital (GOSH).

A team of surgeons, physicians, imaging specialists, nurses and others had to plan, to separate their blood vessels and blood flows while still joined together at the head, then to prepare skin and flesh to allow for the separation, and then finally, on 15_August, to separate the girls safely.

Conjoined twins are very rare and only 5% of conjoined twins are Craniopagus.

Approximately 40 of those percent are stillborn or die during labour, one third die within 24 hours. So for craniopagus twins to survive early infancy is a 1 in 10 million occurrence.

Rital and Ritag Gaboura were ?Total Type III’ Craniopagus, that is, significant blood flows between their brains, the most difficult type to address. Ritag supplied half her sister’s brain with blood, whilst draining most of it back to her heart, therefore doing most of the work. This meant that Ritag’s heart had to pump much harder than Rital’s and was effectively doing most of the work for both of the twins. The strain on Ritag’s heart was too much for her and by the time the twins arrived in the UK, Ritag’s heart was already failing. This was a life threatening situation and significant drops in brain blood pressure would cause severe neurological damage.

Mother and father Drs Enas and Abdelmajeed Gaboura, approached many institutions for help. Great Ormond Street Hospital had the world-class medical experience and Facing the World the contacts and ability to provide assessment, support, logistics and to fund the treatment. London was the family’s best option for a safe separation and the hope of returning home with two, separated, healthy girls.

Mr David Dunaway led the multidisciplinary team alongside Mr Owase Jeelani (lead neurosurgeon) and specialists from several other departments.

Source: Great Ormond Street Hospital for Children, UK

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