The Hindu : National : Separation of twins possible, say doctors

Online edition of India's National Newspaper
Wednesday, Oct 05, 2005

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National

Separation of twins possible, say doctors

Staff Reporter

The envisaged surgery, a complex six-stage procedure, involves massive restructuring and grafting

NEW DELHI: It all came down to the angiography.

The procedure, supervised by Benjamin S. Carson, Professor and Director, Paediatric Neurosurgery, Johns Hopkins Children's Centre, validated the conclusion of the 60-odd physicians at Delhi's Indraprastha Apollo Hospital and Johns Hopkins Children's Centre in Baltimore — that the separation of the 10-year-old conjoined twins, Sabah and Farah Shakeel, was possible.

Kidney transplant

The envisaged surgery, a complex six-stage procedure, would continue through the autumn of next year and involve massive restructuring and grafting. A major concern would be the separation of the brain circulatory system and the kidney transplant after the separation of the twins.

A final decision on the surgery would, however, be taken by the Patna-based parents, who have decided to wait till Ramzan.

Twins conjoined at the head, called carniopagus, are extremely rare and their incidence is one in two million births. The twins, who came to Delhi last Saturday, underwent tests to gauge the risk involved in separating them.

At a press conference on Tuesday, Anupam Sibal, group medical director and senior child specialist, Apollo Hospitals, said, "The surgery is possible and the combined team of Apollo and Johns Hopkins can do it."

Stating that a "tentative" procedure had been chalked out, Dr. Carson said, "The separation would require multiple steps and multiple surgeries. For the surgery, the first step would be to make a virtual reality model to conduct mock exercises before the actual separation of the twins. Three months later, a test occlusion will be carried out for redistribution of the vascular supply of the brain. This would be followed by distraction of the blood vessel after about two weeks to allow the individual brain cells to start the process of separation."

Skin deficit

"The next stage would involve the expertise of plastic surgeons to make up for any skin deficit after this surgery. Following this, it will take about three months before we arrive at a fixed date for the actual separation. Further, renal transplant will also be undertaken for Sabah who in the absence of a kidney is totally dependent on Farah for the same," he said.

Rising blood pressure

Highlighting the fact that surgery was "important" to give the twins a fair chance at leading a full life, Dr. Carson, who has conducted five of the 10 recorded surgeries on such twins across the world, said, "One of the twins is already displaying symptoms of stress on her heart and also rising blood pressure. Also, with the shared kidney, the chances of the children leading a healthy life is compromised."

The cost of evaluations and "possible surgery" was being funded by the Crown Prince of Abu Dhabi, Sheikh Mohammed Bin Zayed Al Nahayan, who approached the girls' father through the UAE Embassy here.

Apollo Hospitals has established a separate "Sabah and Farah Fund" to support the needs of the family and to compensate for the prolonged loss of livelihood due to their stay in Delhi for surgery.

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