Joined at the skull: Rare Among Twins, Separation Rarer

Joined at the skull: Rare Among Twins, Separation Rarer File Photo

Doctors at AIIMS have completed first stage of surgery on Odisha twins; The Indian Express explains what has been done, what lies ahead

What is unusual about the ongoing surgery on conjoined twins at AIIMS?

Two-year-old twins Jagannath and Balram of Odisha are craniophagus twins, or twins conjoined at the skull. It is very rare: Out of every 3 million children, only one is a conjoined twin; and out of all conjoined twins, only 2% are craniophagus twins.

To what extent are the Odisha twins conjoined?

In one twin, 70% of the brain is infused; in the other, 30% is infused. They are joined at the top of their heads with their bodies at 180 degrees to each other. This is called vertical craniophagus.

So, there are other kinds?

Vertical craniophagus is one of four ways twins can be joined at the skull. In occipital craniopagus, the twins are joined at the back of the head; in frontal craniopagus, they are joined at the forehead; in parietal craniopagus, they are joined at the side of the head.

How far is surgery possible?

To decide whether or not separation surgery is possible, doctors assess factors such as whether the twins share vital organs and are healthy enough to withstand surgery. Of all conjoined twins, 50% die either at birth or within 24 hours, surgery is feasible only on 25% of the survivors, and the rest continue to live with the condition, says Dr Deepak Gupta, professor of neurology at AIIMS, and part of the team conducting the country’s first craniopagus surgery. He says two pairs of Indian craniopagus twins — Vani and Veena in Hyderabad ; and Sara and Farah in Patna — are living without separation.

And how far is surgery successful?

There is a less than 20% chance of survival among craniophagus twins who undergo separation surgery, says Dr Gupta. Across the world, there have been 60 craniophagus separation surgeries since 1952.

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Latest news, Conjoined twins, Twins