Surgical Tribune Europe

Conjoined twin sisters separated after 50 hours of surgery

July 17, 2019

LONDON, UK: A pair of twins, who were conjoined at the head, are finally living independent lives after a 100-strong team of British medical experts spent 50 hours performing complex surgery to separate them.

Around two in five sets of craniopagus twins are stillborn or die during labor, while a third more do not survive the first 24 hours. Fortunately in the case of Safa and Marwa Ullah, born in January 2017, a wealthy benefactor offered to cover the costs of their long journey from home in Charsadda, Pakistan, for the surgery at London’s Great Ormond Street Hospital (GOSH).

Born by cesarean section, the girls emerged with their skulls and blood vessels fused together. Since arriving in Britain, they have undergone three operations between October of last year and when they were finally separated on February 11. Such a procedure is extraordinarily rare; according to GOSH, the chances of craniopagus twins undergoing surgery is around one in 10 million. Around 5% of conjoined twins are craniopagus cases.

After consultation with their doctors in Pakistan, the London hospital welcomed the family to the Bumblebee Ward where various experts—from craniofacial, neurology and psychology specialists, to nurses, radiologists and physiotherapists—spent four months treating them. Consultant neurosurgeon Noor ul Owase Jeelani and craniofacial surgeon Professor David Dunaway led a team of 100 staff members. Jeelani explained that conjoined twins are “very, very unusual,” but even more so those joined at the head.

The secret of the “very complex procedures,” according to Jeelani, was breaking it down to smaller and “much more manageable steps.” The experts used virtual reality to create an exact replica of the girls’ anatomy in order to visualise their skulls and the positioning of their brains and blood vessels.

“For the first two to three procedures we focused on separating out the brains and blood vessels,” said Jeelani. Once this was completed, a piece of plastic was used to keep the two structures apart. “Internally we had two separate kids,” the neurosurgeon added. The focus was then external, as the team used the girls’ own bone at the top of their skulls and “tissue expanders” to stretch their skin over their heads.

Having been discharged on July 1, the girls are said to be doing well despite the many challenges ahead. Their mother Zainab Bibi, 34, is currently residing with them in London where they are undergoing daily physiotherapy. Bibi, who had seven children prior to the twins, said in a statement: “We are indebted to the hospital and to the staff and we would like to thank them for everything they have done. We are extremely excited about the future.” Jeelani said he was optimistic that the twins would be walking by their third birthday. “From our personal point of view, it has been great to get to know the girls and their family. Their faith and determination have been so important in getting them through the challenges they have faced. We are incredibly proud of them,” Jeelani and Dunaway added in a statement.

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