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Conjoined twins, separated in Israel last month, leave hospital

CM 23/10/2021

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One-year-old twin girls, who had been conjoined at the back of their head and separated by a team of doctors at Soroka University Medical Center in a rare and nearly miraculous surgery last month, have gone home.
The children were released on Thursday but will continue to receive outpatient medical treatment at the hospital. They have been under local and international evaluation and treatment since their birth in August 2020.
“There is a tremendous sense of satisfaction for everyone who participated in the process,” said Dr. Mickey Gideon, director of pediatric neurosurgery at Soroka. “We accompanied the twins during the mother’s pregnancy, prior to the operation and in the last month in the hospital in the pediatric intensive care unit and then the pediatric surgery unit, and we will be there for them long after.”
The operation the children underwent is extremely rare – performed so far only around 20 times in the world. They were the first conjoined twins to undergo the operation in Israel and also among the youngest in the world on which this procedure has been performed.
According to research published by the University of California’s UC Davis Health last year, craniopagus twins occur about once in every 2.5 million births.

 One of the twins during physiotherapy at the Soroka Child Development Institute (credit: Courtesy) One of the twins during physiotherapy at the Soroka Child Development Institute (credit: Courtesy)

The 12-hour procedure involved dozens of staff members, many who had been working with the parents since the birth of their daughters. This included neurosurgery, plastic surgery, pediatric anesthesia, pediatric intensive care and brain-imaging specialists.
The doctors leveraged advanced equipment and technology, some of which had to be brought to the hospital especially for the procedure. This included 3D modeling, virtual reality and special monitoring devices.
Specifically, they used STRATASYS, 3D4OP 3D models based on images from MRI, CT and angiography scans that simulated the complexity of the connection between the twins’ blood vessels, meninges, skull bones and skin.
Using the VR model called Surgical Theater, the team was able to make simulations of the procedure and plan it in the most exact manner. Dozens of simulations of all the stages of the operation were performed in each model before the day of the surgery.
During the operation itself, after the separation of the blood vessels was successful, the bones were separated. The doctors then split into two teams to work in parallel in two separate operating rooms, performing a reconstruction of the skull of each girl and closing the skin.
After the operation, the twins were hospitalized for about a month, Gideon explained, during which time they recovered without complications. They also received physiotherapy treatments to bridge their motor gap, because until the surgery, they could not turn on their stomachs or sit down, since they were connected.
“Today they are already flipping, and the more dominant twin has even started to sit up,” Gideon said. “The girls are expected to continue the intensive rehabilitation process even after their release.”
In the future, he said, they may need additional surgeries, most likely aesthetic surgeries of the skull structure.
“This day is especially exciting for me,” Gideon said on Thursday. “Beyond a professionally significant milestone in the planning, execution and implementation of an operation of a magnitude not previously seen in Israel… I have been associated with twins in an extraordinary way. The understanding that this complex procedure significantly affects their future, strengthens me and all the teams that were involved.”

Source: Jerusalem Post

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