10 months old conjoined twins Abby and Erin Delaney were operated successfully at Children’s Hospital of Philadelphia in south-eastern Pennsylvania. The girls from North Carolina were operated after several months of planning and preparation. A successful 11-hour separation surgery was performed last week. The girls were joined at the head which is extremely rare condition. "Separating conjoined twins is a very complex surgery followed by a long and complicated recovery, but we are very hopeful for a positive outcome," Jesse Taylor, a plastic surgeon who co-led the operation with neurosurgeon Gregory Heuer, said Tuesday in a statement from the hospital. "Erin and Abby are now recovering in our Paediatric Intensive Care Unit under close monitoring by our expert teams."
According to the University of Maryland Medical Centre, in an identical twin’s case, an embryo separates in too early in a pregnancy; but with conjoined twins, the embryo does not separate totally and the twins remain connected. Conjoined twins are rare, occurring once in about every 200,000 births - and craniopagus twins, those who are connected at the head, are the rarest form, accounting for about 2 percent of conjoined twins, according to the medical centre.
Experts says that most craniopagus twins do not survive. The gravity of the condition depends on how and where the conjoined twins are connected. Abby and Erin's parents, Riley and Heather Delaney, learned that their girls were conjoined early last year when Heather Delaney was pregnant at 11 weeks.
The hospital told that it was too soon to know whether the twins would be able to be separated, Heather Delaney travelled to Pennsylvania from North Carolina for her prenatal care. Ultimately, she shifted into a hospital facility in Philadelphia for mothers carrying babies with complex congenital conditions, according to the hospital.
The hospital also released a statement stating that Abby and Erin were delivered by C-section 10 weeks prematurely, each weighing about 2 pounds last July. Doctors started planning the operations long time ago to separate them. Alan R. Cohen, chief of paediatric neurosurgery at Johns Hopkins Hospital, said that he could not comment on the Delaneys' case particularly but that separating craniopagus twins "can be a high-risk surgery."
Cohen said surgeries are done at major medical centres where teams of neurosurgeons, plastic surgeons, anaesthesiologists and critical-care physicians spend months studying patients' brain scans and, often, 3-D models "to try to find the safest way to make the disconnection."
"Depending on where the heads are joined and how much they are fused, that determines the complexity of the operation," Cohen said. He added that "the most feared complication of the surgery is how to manage the shared blood vessels - particularly the veins that drain the brain - because usually one twin gets the good veins and the other doesn't."
He said "success" means the surgeons can separate the twins, but "in terms of the long-term prognosis, it's usually a long road ahead for the family and the medical team caring for them." The night before the Delaney’s surgery on June 6, someone posted on a Facebook page set up for the twins. "The girls have a big procedure tomorrow," the post read. "We ask for as many prayers as you can spare. It will be a long day for us." Many days later, the messages asked others to "bear with us" and "keep praying for us."
"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," Heuer, the neurosurgeon, said in the statement. "Finally, we divided our team into two halves, one for each of the girls, and finished the reconstruction portion of the surgery."
The hospital has said that few more surgeries will be required but for the time being they can go home. "When we go home, it's going to be a big party," Heather Delaney said in a statement from the hospital. "Welcome home, baby shower, first birthday."