Twin sisters, Safa and Marwa, who were conjoined at the head at birth, were recently separated in a series of successful operations in London.
It took a team of around 100 healthcare professionals at Great Ormond Street Hospital (GOSH) and over 50 hours of surgery to carry out the task.
We’ve an incredible story to share with you: conjoined twins Safa and Marwa have been successfully separated – the first such procedure at @GreatOrmondSt since 2011! Discover their extraordinary story. https://t.co/aKrOCMGu3q 🎉🏥 pic.twitter.com/zePGMMrdIt
— Great Ormond Street Hospital (@GreatOrmondSt) July 15, 2019
The twins were born at Hayatabad hospital in Peshawar, Khyber Pakhtunkhwa on January 17. Local hospitals could not guarantee that both would survive if they carried out separation. Their mother did not want to take the risk and so they were put in touch with a neurosurgeon at GOSH.
Four operations later, the girls-now two years old- are alive, healthy and living with their family in London.
A rare case of conjoined twins
Known as craniophagus twins, Safa and Marwa shared a skull and blood vessels which left their brains distorted.
Plastic surgeon Dr David Dunaway said they had carried out successful separation procedures on craniophagus twins before, but Safa and Marwa’s case was far more difficult
“The first two cases were much more straightforward and we were lucky. But with this set we underestimated the complexity of the oblique brain joining. Also, they are older and I think older is really bad news.”
The ideal time for such a surgery is between six and 12 months of age.
Conjoined twins are already rare- only one in 200,000 births. Craniophagus twins are even rarer; they make up only 5% of all conjoined twins. Some statistics put their survival rate between 5% and 25%.
Their surgery was funded by a generous Pakistani businessman.
Murtaza Lakhani, a wealthy businessman, sponsored Safa and Marwa’s surgery after hearing of their case from their surgeon, Owase Jeelani, reported the BBC. Lakhani’s reasons for helping out were a shared nationality and a sense of responsibility towards their future.
It took four complicated procedures over four months to separate them.
The complex surgery had to be broken down into small procedures to manage it safely. The team first mapped their anatomy in virtual reality and practiced on 3D models to prepare for the surgery.
Professionals at the hospital gave a step-by-step breakdown of the procedure in videos posted on their social media platforms.
In October 2018, they carried out a detailed assessment of both children noting how their blood vessels, brains, skulls and soft tissues were connected. The initial two to three procedures focused on separating their brains and blood vessels. This proved tricky as cutting off blood supply in one twin’s head could lead to a stroke in the other twin.
After the brains were separated, a sheet of plastic was placed in between them in the skull to prevent them from reconnecting.
The surgeons then moved on to the skull and tissues. They placed tissue expanders underneath the skin to make it grow and cover the missing area over the two reconstructed skulls. The whole process took six weeks. The top of their heads were closed up and the twins were finally separated in February, 2011.