Twin girls joined at the head separated successfully by team of doctors at CHOP

By Dr. Ananya Mandal, MDJun 14 2017

Twins girls Abby and Erin Delaney are 10 months old and were conjoined at their head until an 11 hour separation surgery last week at Children’s Hospital of Philadelphia in south eastern Pennsylvania.

The North Carolina girls who underwent this surgery were born with their heads connected. Like most identical twins the two embyros tend to split into two in early pregnancy. In case of conjoined twins the separation is not complete.

Jesse Taylor, a plastic surgeon who co-led the operation with neurosurgeon Gregory Heuer in their statement said that this was a very complex surgery and this would require a long and complicated recovery phase before the two are completely normal and ready to go home. The twins are recovering at present in their Pediatric Intensive Care Unit under close monitoring they said.

Conjoined twins who are connected at their heads are called craniopagus twins. Conjoined twins occur rarely as such with once in every 200,000 births. Of these only 2% are craniopagus say experts. This is a rare form of conjoined twins. The survival of either twin or both depends on the extent and type of connection between the two say the expert team. Most craniopagus twins do not survive say experts.

Riley and Heather Delaney, the parents of Abby and Erin, became aware that Heather was carrying craniopagus twins when she was 11 weeks pregnant. Heather Delaney travelled to Pennsylvania for her prenatal care right after that to ensure a better outcome for her babies. It was still too soon to know if the twins would separate or what would be their fate at birth. The hospital facility at Philadelphia, Children’s Hospital of Philadelphia – CHOP, specializes in mothers who are pregnant with babies who have congenital conditions. Abby and Erin were delivered by C-section 10 weeks before the expected dates of delivery on July 24, 2016. They weighed around 2 pounds each.

Since then they were intensively cared for and their separation was planned meticulously. This surgery is a complex one involving high risks say other experts in the field. It requires a team of neurosurgeons, plastic surgeons, pediatric surgeons, critical-care physicians and anesthetists. Brain scans and 3D models of the brain are extensively studied to find the best and safest possible method to separate the connection say experts. The complexity of the operation is directly dependent on the extent of the connection and on where the babies are joined including the blood vessels and brain tissues that the twins are sharing. Separation surgeries are also ethical issues say experts in the field. Both twins may not survive the ordeal and one of the twins may receive poorer blood supplies or tissues compared to other. One of them may have more neurological problems compared to the other.

It may be some time before we know the outcome of this surgery in terms of neurological success said the team. The surgery on 6th of June included a team of thirty doctors, nurses and other medical personnel. This was a first operation of its kind for this hospital. The hospital has separated 22 other pairs of conjoined twins over the last six decades but this was the first craniopagus twin they worked on. Extensive planning went into the surgery with each baby being colour coded green or purple. The team worked on a single body before separation followed by splitting into two teams once the babies were apart. First the shared blood vessels and linings of the brain (dura mater – a membrane protecting the brain) were separated. A major part of the brain, the saggital sinus was then separated. Then the girls were split as were the teams who performed the reconstruction surgeries said Heuer. The twins are likely to go home later this year but may require further surgeries.