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Ray of hope for Conjoined twins ,Veena and Vani

Veena and Vani, 11 year old Craniopagus twins can look forward to separate and enjoy an independent life. Neuro-surgeons, Dr David Dunaway and Dr OwaseJeelani from Great Ormond Street Hospital, London – have given 80 per cent chance for a successful surgery that would separate the twins and make it possible to live normally.

 

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They have already handled successfully two similar cases in the past. Four years ago, they had done a similar surgery on one-year-old Sudan conjoined twins. “CT scans and other medical history of Veena and Vani are anatomically similar to the Sudan case. Need to do some more tests and prepare 3D models of the brains and vascular system to understand sharing of blood between the two,” surgeons said.

Doctors said , this surgery would be done in five stages, which would take at least 8 to 12 months. The twins’ relatives will also have to be there during the course of the surgery. Around 50 to 100 healthcare workers, including specialists, would be working on this case.

About the complication that might arise during the surgery, The Doctors said, “There might be a lot of complications like blood loss. They might experience brain injury or damage. Chances of that are low, but not zero. But there are 80 per cent chances for the surgery to be good”.

 Man of Medical Miracles :Noor ulOwaseJeelani

Owase Jeelani is Specialty Lead for Neurosurgery at the Great Ormond Street Hospital, London. The hospital is one among the top 5 children’s hospitals in the world and the Department of Neurosurgery is one of the largest paediatric neurosurgery services globally.

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Specialisms

  • Craniofacial and Trauma Reconstructive Surgery
  • Surgical Neuro-oncology
  • Hydrocephalus and Intracranial Pressure Pathology

Qualifications and training

BMedSci, MBBS, MBA, MPhil (Medical Law), FRCS (NeuroSurg.)

Clinical practice

Mr Jeelani undertakes between 200-300 paediatric neurosurgical and craniofacial cases per annum.

Mr Jeelani was the lead neurosurgeon for the successful separation of the Sudanese Conjoined twins .In 2011,The Times listed him as one of the top British Surgeons.

Sudanese Conjoined twins

In 2011, surgeons from Great Ormond Street Hospital (GOSH) performed pioneering surgery on conjoined twins Rital and RitagGaboura.

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Born on 22 September 2010 in Sudan, Rital andRitag were joined at the head. It’s a great challenge to handle this case for even the best medical experts in the world.

On the right path

GOSH and Facing the World, a British charity providing life-changing reconstructive surgery to children with severe facial disfigurements, came to the rescue the little girls.

One in 10 million

Rital and RitagGaboura were total type III craniopagus (joined at the head). The twins’ brains touched, and Ritag is supplying half her sister’s brain with blood, while draining most of the blood back to her heart, therefore doing most of the work. Her kidneys were also doing most of the urine production for both of them.

Conjoined twins are very rare, and only five per cent of them are joined at the head. Out of which approximately 40% are stillborn or die during labour, while one third die within 24 hours. It’sone in 10 million occurrence for the craniopagus twins to survive to early infancy Unfortunately, 78% die by the age of one and 90% die by the age of 10.

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Preparing for surgery

Single vs multiple operations

Traditionally, craniopagus twins have been separated in a single go. The problem with this is that the shared veins draining the brain have to be given to one twin. This prevents blood flowing away from the parts of the brain deprived of their venous drainage, which in turn causes an increase in pressure in the brain, which eventually leads to brain damage or death. Single stage operations have therefore either been fatal or have caused significant brain damage.

Multi-stage surgery separates the twins in stages. This has the effect of reducing the rise in venous pressure seen to a level that does not cause brain damage. The brain gradually recovers from the partial venous separation and over the span of a few days, new venous channels open and the venous pressure returns to normal as blood flows away through these new channels. Once the venous pressure has returned to normal, the next stage can be undertaken and the process repeated. In this way, the brains are gradually and safely separated.

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After the separation: Ritag and RitalGaboura

The operations

Rital and Ritag required four complex operations at GOSH. A team of surgeons, physicians, imaging specialists, nurses and others had to plan, separate their blood vessels and blood flows while still joined together at the head, then prepare skin and flesh to allow for the separation, and then finally, on 15 August, separate the girls safely.

Consultant Craniofacial and Plastic Surgeon, Mr David Dunaway, led the multidisciplinary team alongside Consultant Paediatric Neurosurgeon, Mr Owase Jeelani, and specialists from several other departments.

  • The first two operations- portions of the twins’ shared vascular system are separated. This was vital to ensure safety during the final procedure and to reduce Rital’s dependency on her twin. Time was of the essence as Ritag’s heart was starting to fail.
  • The third procedure – inserted tissue expanders to stretch the skin needed to cover their heads at the fourth stage.
  • On 15 August 2011, The final procedure took place to separate the twins.

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The Gaboura family with the GOSH surgeons

At-a-glance timeline (2011)

13 April Twins arrive in the UK
9 May First vascular separation surgery – 10 hours
16 May Second vascular separation surgery – 10 hours
4 July Tissue expanders inserted – six hours
15 August Final separation – 13 hours

 

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