View our five-part video series of the first-ever separation of conjoined pair at UC Davis Children"s Hospital.
You are watching: Conjoined twins at the head update
The north Highlands (Sacramento County) twins to be born linked at the head, a condition called craniopagus twins. Conjoined twins are already extremely rare, however craniopagus twins are even more so. Just two percent of conjoined twins space born unify at the head. Craniopagus twins take place in around one in every 2.5 million births.
The 24-hour surgical procedure took location in the UC Davis Children’s Surgery facility in an operation room that was custom-built because that this level of operation complexity. This to be the very first separation of conjoined twins at UC Davis Children’s Hospital. The team of specialists included much more than 30 people: surgeons, nurses, anesthesiologists and also other an essential surgical staff. They were led through pediatric neurosurgeon Michael Edwards, cook of plastic surgical procedure Granger Wong, manager of pediatric anesthesiology Rajvinder Dhamrait and also Children’s Surgery center nursing lead Aida Benitez.
“This is a landmark surgical treatment for united state at UC Davis Children’s Hospital,” claimed Edwards, that has had actually previous success separating conjoined twins. “Abigail and Micaela room doing well and recovering in our Pediatric Intensive care Unit, many thanks to an remarkable team effort committed to ensuring these an extremely rare twins have the best shot in ~ a elafilador.nety and balanced life ahead. We space honored to have promoted their birth, cared for them since, and also to now provide them the possibility to live independent and separate lives.”
Planning for the bear of conjoined twins
UC Davis wellness has listed care for Abigail and Micaela indigenous the start — even before birth.
Mom Liliya, 33, got the news that she to be pregnant through conjoined twins as soon as she to be 11 main pregnant. Her medical professional referred her to the UC Davis Fetal Care and also Treatment facility for the comprehensive prenatal care she needed. That is the only an extensive fetal diagnosis and therapy facility in inland north California.
A fetal MRI listed more details around the anatomic structures of the twins. Conjoined manikin dolls were arisen based on the MRI. This helped the team identify difficulties with the twins’ positioning and assisted in to plan for your delivery.
Simulations and also scenarios were practiced for months to prepare for numerous feasible risks: compromised airways, collapsed lungs, the require for a CPAP an equipment to aid in breathing or IV placement. CPAP headgear was custom-designed because that each girl. The choreography was practiced and repeated because that each scenario.
Abigail and Micaela to be born at UC Davis Children’s Hospital on Dec. 30, 2019. Lock spent 7 weeks in the Neonatal Intensive treatment Unit (NICU) before going home.
“We have actually felt so lot support indigenous staff. We have actually received so much help, so much advice. It has made us feel at residence here,” Liliya said.
Separating twins conjoined at the head
Surgeons decided to separate the conjoined twins at nine months the age. They go not want to wait longer.
“As they gain older, there are an ext risks of shared blood vessels and organs coming to be larger or an ext entwined. The upcoming flu, COVID-19 and RSV season was additionally a concern,” command plastic surgeon Granger Wong said.
To prepare for the procedure, the operation team invested months closely tracking the twins’ development through MRIs and also CT scans.
In June, Wong’s team placed custom-designed organization expanders under the skin that the girls’ heads to encourage an ext skin come grow. This would certainly ensure sufficient skin to cover the exposed area of your skulls upon separation.
High-tech preparation for the surgery had the 3D to press of lot of models that the twins’ unify skulls. The models enabled the team to plan and practice the surgical treatment with a high level of precision. Surgeons additionally were may be to explore inside the twins’ heads v the usage of mixed reality goggles. The technology detailed an augmented view of the facility network of blood vessels the team would need to detangle and also separate – before ever bringing the twins into the operating room.
The surgical team and family retained in close touch in the month leading approximately the procedure. The operated doctor made routine house calls to the family’s home, therefore the family members would not require to concerned the clinic for checkups between the COVID-19 pandemic.
The separation surgery
Finally, this previous Saturday, the practicing became reality for a team of an ext than 30 surgical professionals.
With for this reason many an essential players in one space, each through a distinct role to play, the team members were split by color. Leaders Edwards, Wong, Dhamrait and also Benitez donned black color caps. Team purple took care of Micaela, if Team Orange cared for Abigail; castle donned surgical caps in either violet or orange for easy visibility in the operating room. Surgical inhabitants wore grey caps and also could help with either girl. Purple and orange masking ice were provided to label equipment for the respective teams in the operation room.
Overall command and control to be led by Dhamrait and Benitez.
The plastic surgeon made the initial incisions. “It was like a choreographed ballet,” said Wong, who also created the style of skin flaps, removed the expanders and reconstructed the skull and also scalp after ~ the twins were separated.
Surgical difficulties included dividing huge veins and mind matter that connected the twins so they could have independent circulatory systems. The team performed a fistula ligation, a procedure that associated clipping and separating mutual veins. During the surgery, the pair required five position changes, every one of which make potential complications. They additionally needed blood transfusions throughout the procedure.
Edwards announced, “Cranial separation!” when the babies to be officially separated in ~ 3:28 a.m. The surgical team clapped and also cheered.
“After 10 months of preparation, we were evil what we had all envisioned because that the girls and also we were get rid of with emotion and joy,” claimed Benitez. “I will never see 3:28 ~ above a clock again and also not think that the minute that Abi and also Mica came to be two separate babies.”
Conjoined twins separated: “It was flawless”
Dhamrait led a team of 6 anesthesiologists that administered anesthesia and also medication to preserve the twins’ blood press during and also after separation. The twins’ mutual anatomy complex each anesthetic. “We were fortunate that we had actually anesthetized the twins four times prior,” said Dhamrait, who has actually taken part in a conjoined twins separation before. “It to be flawless, with all contingencies covered.”
Throughout the 24-hour procedure, Benitez noted regular updates to the family, that was praying and also nervously awaiting news around their girls.
Twenty-four hours later, ~ above Sunday morning, the formerly joined twins were relaxing comfortably — and also separately — in their room in the UC Davis Pediatric Intensive care Unit.
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“Everything went well. That felt practically impossible to separate them, however God and the doctors and also nurses at UC Davis made the possible. We room so thankful,” Liliya said.