A day after two-year-old twins from Odisha, who are joined at the head, were admitted to AIIMS, the premier hospital is set to constitute a team of specialists to examine the feasibility of conducting India’s first craniopagus surgery to separate the two. Only 59 such surgeries have taken place in the world since 1973 — the most recent one in New York in November, 2016.
AIIMS director Dr Randeep Guleria said that initial investigation of the twins, Jagannath and Balram, revealed that there is “a lot of of brain fusion, lumps in the neck, chest infection and malnourishment”. “We will form a team to look into how best we can manage the children. A team of specialists, including psychologists, paediatricians, neurosurgeons, neuro-radiologists and others, will look into feasibility of the surgery. We have all facilities at AIIMS but our priority is to build nutrition levels. Only when they are anaesthesia-fit will the specialists examine feasibility of the surgery,” Dr Guleria said.
A team of specialists Saturday highlighted challenges that AIIMS faces to undertake the “rare and unique medical condition”: Deciding who survives Dr A K Mahapatra, chief of the neuro sciences centre at AIIMS, said one baby has “more brain infused than the other”. “In one, 70% of the brain is infused and in the other it is 30%. We will examine the chances of survival — whether we can save both or just one,” Dr Mahapatra said.
A long procedure
Dr Mahapatra said that if the surgery takes place, it will take 10-50 hours to complete the reconstruction. “Which means they will be under anaesthesia for a long duration. Also, there is a large loss of blood. The first challenge is to nourish the children and make them anaesthesia-fit,” Dr Mahapatra said. “An MRI and brain mapping examination is needed to check how impaired the brain functioning is. We also have to assess the residual neuro deficit and decide the feasibility of the surgery accordingly,” Dr Guleria said.
Dr Deepak Gupta, professor of neurosurgery at AIIMS, said that if given the go-ahead, the operation will include “three-five surgeries” and “two teams will be formed to operate on the twins simultaneously”. “Their collective weight is just 20 kg. Because the blood volume is low, we will have to conduct a staged operation,” Dr Gupta said. Advance preparation
Dr Gupta said that if the surgery is feasible, a “prototype” of the brain will be built. “We will plan the surgery from outside the actual operation theatre. Based on images from the CT scan, we will build a model on the computer. We will then have plastic models and accordingly we can then decide where cuts are required,” Dr Gupta said.