Conjoined twins can have 'normal lives' after Vatican hospital performs separation surgery

CNA Staff, Jul 8, 2020 / 12:00 pm

Twins who were conjoined at the head are likely to return home within months from the Vatican's pediatric hospital where their bodies were successfully separated by doctors, and they have a high chance of living normal lives, the hospital's chief neurosurgeon told CNA.

The Bambino Gesù Hospital announced the successful separation surgery July 7, saying it was the first operation of its kind in Italy and probably the world.

The final stage of surgery, which took place on June 5, lasted 18 hours and involved more than 30 medical staff. The two-year-old sisters are expected to make a full recovery.

"We have been able to accomplish an extraordinary result despite such a complex malformation, being able to separate with an optimal clinical result. From a neurological standpoint, the two little girls are doing very well and have excellent prognosis for normal lives in the future," Dr. Carlo Efisio Marras, director of neurosurgery of the Bambino Gesù hospital told CNA July 8.

"This accomplishment is the fruit of more than a yearlong work of investigation and preparation involving several specialties and professions within the hospital. There were many difficult phases since several surgical procedures were needed, each one with its own challenges," Marras told CNA

"But the most difficult one involved the venous system, that is, the network of vases that brings blood from the heart to the brain to bring oxygen to it. If we would have not succeeded in deal with this system shared by both babies, the result would had been catastrophic."

"But the two little twins are well: we believe they can be released in a few months. They will have to go through a rehabilitation phase to learn the motions they were not able to perform previously. I wholeheartedly wish them a happy future. They are now in the condition to return to a normal life." 

"I have to thank my hospital, which is known for bringing together research, development and solidarity, for this extraordinary experience," Marras added.

The hospital said the twins, Ervina and Prefina, were born on June 29, 2018 in a village about 60 miles outside Bangui, the capital of the Central African Republic. They were joined together with "one of the rarest and most complex forms of cranial and cerebral fusion," known as total posterior craniopagus.

Mariella Enoc, president of the Bambino Gesù, met the twins in July 2018, during a visit to Bangui, where the sisters had been transferred after their birth. Enoc was helping to oversee the expansion of pediatric services in the country, which is one of the world's poorest, in response to an appeal from Pope Francis. She decided to bring the girls to Rome for surgery.

"When you encounter lives that can be saved, it must be done. We cannot and must not look away," she said at a press conference Tuesday.

The twins arrived in Italy with their mother, Ermine, on September 10, 2018. Initial tests confirmed the sisters were healthy, but had different blood pressures, indicating that one of the girls' hearts had to work harder to maintain the healthy functioning of their organs, including their brains.

The hospital said the twins were joined via the back of the head, including the nape, sharing both skin and cranial bones. But the greatest challenge for doctors was that they were joined at a deeper level, sharing membranes inside the skull as well as the venous system, through which blood used by the brain is transported back to the heart.

The hospital emphasized that the sisters had distinct personalities, describing Prefina as "playful and lively," and Ervina as "more serious and observant."

A multidisciplinary team, including neurosurgeons, anesthesiologists, and plastic surgeons, prepared for more than a year for the operation to separate the twins. The hospital's ethics committee contributed to a plan ensuring that the girls would have the same quality of life.

The separation took place in three stages. In the first, in May 2019, neurosurgeons started to separate and rebuild the membranes and venous systems.

The second, a month later, focused on the confluence of sinuses in the brain. The hospital said it was a critical phase of the treatment as "the operating space is a few millimeters."

The two operations prepared the girls for the third and final phase of complete separation on June 5.

"It was an exciting moment, a fantastic, unrepeatable experience. It was a very ambitious goal and we did everything we could to achieve it, with passion, optimism and joy. By sharing each step, studying every single detail together," Marras said.

Bambino Gesù, colloquially known as the "Pope's hospital," is among the most important pediatric hospitals in the world. Founded in 1869 by the Duchess Arabella Salviati, the hospital was donated to Pius XI in 1924, with the aim of giving it a more stable future. While the hospital is located in Rome, rather than Vatican City, it is situated in an extraterritorial area administered by the Holy See.

The hospital said Tuesday: "A month after the final separation, the twins are doing well. … On June 29 they celebrated their second birthdays, looking into each other's eyes, moving their little hands to the rhythm of music, in the arms of their mother."

"They have undergone very difficult operations; the wounds will take some time to heal; the risk of infection is still present. The neurorehabilitation program continues and for a few months they will have to wear a protective helmet."

"But post-operative checks indicate that the brain is intact. The recreated system works, the blood flow has adapted to the new path."

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Speaking at the press conference, the girl's mother, Ermine, said: "If we had stayed in Africa I don't know what fate they would have had. Now that they are separate and well, I would like them to be baptized by Pope Francis who has always taken care of the children of Bangui. My little ones can now grow up, study and become doctors to save other children."