Nav: Home

High-tech tools, teamwork were key to separating infant girls joined at the head

January 23, 2019

Over a year and a half after the successful separation of two infant twins joined at the top of their heads, surgical team leaders report on this dramatic case in the Jan. 24 New England Journal of Medicine. The surgeons describe the innovative devices, elaborate planning and precisely orchestrated teamwork needed to perform the complex separation surgery at Children's Hospital of Philadelphia (CHOP).

Today Erin and Abby Delaney are thriving two-year-olds, living with their parents Heather and Riley in Mooresville, N.C. In June 2017, their 11-hour separation surgery made them international celebrities at 10 months of age. Among craniopagus conjoined twins (those joined at the head), they were among the youngest ever known to be successfully separated.

"Infants with this condition heal faster and better the younger they are at separation, because of the plasticity and regenerative powers of the young brain," said neurosurgeon Gregory Heuer, MD, PhD, who co-led the surgery with plastic surgeon Jesse Taylor, MD, as members of a 30-person multidisciplinary team. "However, we need to balance this advantage against the risks of performing major surgery in infants, especially in such an extremely rare complex condition."

For conjoined twins, already a rare occurrence, the Delaney twins' condition was among the rarest of the rare. Craniopagus conjoined twins occur about six times in 10 million births, and even more rarely, the girls were totally fused, with their connection extending deep into brain tissue. Of particular concern, they shared a superior sagittal sinus, the large vessel that carries blood from the brain to the heart.

The current report details how the team used and adapted sophisticated surgical technologies for the separation. Computer-aided design and modeling enabled the team to print a three-dimensional model to assist in surgical planning. After surgeons initially cut through the bone where the babies' skulls were joined, the team attached a custom-designed external distraction device, which very gradually pushed the twins apart by one or two millimeters a day prior to full surgical separation months later.

For the final separation surgery, the team used a computer-aided intraoperative navigation system to map the interconnected blood vessels, particularly the sagittal sinus, which needed to be painstakingly divided between the twins. That visualization tool offered continuous knowledge of the surrounding anatomy during the course of surgery, when vessels and brain tissue were sometimes partially obscured.

Erin and Abby moved to the hospital's intensive care unit after the 11-hour separation surgery, and were discharged to inpatient rehabilitation two months later, shortly after their first birthday. Erin was discharged in October 2017, four months after the surgery, and stayed with her parents at the Philadelphia Ronald McDonald House until Abby was discharged one month later. They were finally able to go back home to North Carolina just before Thanksgiving in 2017.

The journal article summarizes the condition of the twins 11 months after separation, when they were 21 months old. Surgeons and clinicians will continue to monitor the girls' progress for years to come. As occurred during their hospital stay, Erin and Abby will continue to be followed by nutritionists, developmental pediatricians and other specialists. In addition, both will need a synthetic implant at age four or five to cover the openings in their skulls necessitated by the separation surgery.

In the meantime, their parents report that Erin and Abby, now two and a half years old, are "exceeding all expectations." Heather Delaney said, "Erin is crawling everywhere and enjoying her new-found freedom...she is so engaged and curious." Her sister Abby is starting to sit up on her own, feisty and sassy. "She rolls around the house like it's her job and gets into everything," added Heather.

"We are so grateful and feel so blessed that we get to be their parents and watch them grow and thrive," said Riley Delaney.

Dr. Taylor, now Chief of the Division of Plastic and Reconstructive Surgery at CHOP, added, "After this long and complicated surgery, these little girls are recovering, developing and growing. We are honored to have helped make this happen."
-end-
Note to Media: To arrange interviews with Drs. Heuer or Taylor, or with Heather and Riley Delaney, please contact Ashley Moore at 267-426-6071 or Moorea1@email.chop.edu

Gregory G. Heuer et al, "Separation of Craniopagus Twins by a Multidisciplinary Team," New England Journal of Medicine, Jan. 24, 2019.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

Children's Hospital of Philadelphia

Related Brain Articles:

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.
An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.
Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.
Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.
Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.
Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.
BRAIN Initiative tool may transform how scientists study brain structure and function
Researchers have developed a high-tech support system that can keep a large mammalian brain from rapidly decomposing in the hours after death, enabling study of certain molecular and cellular functions.
Wiring diagram of the brain provides a clearer picture of brain scan data
In a study published today in the journal BRAIN, neuroscientists led by Michael D.
Blue Brain Project releases first-ever digital 3D brain cell atlas
The Blue Brain Cell Atlas is like ''going from hand-drawn maps to Google Earth'' -- providing previously unavailable information on major cell types, numbers and positions in all 737 brain regions.
Landmark study reveals no benefit to costly and risky brain cooling after brain injury
A landmark study, led by Monash University researchers, has definitively found that the practice of cooling the body and brain in patients who have recently received a severe traumatic brain injury, has no impact on the patient's long-term outcome.
More Brain News and Brain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Processing The Pandemic
Between the pandemic and America's reckoning with racism and police brutality, many of us are anxious, angry, and depressed. This hour, TED Fellow and writer Laurel Braitman helps us process it all.
Now Playing: Science for the People

#568 Poker Face Psychology
Anyone who's seen pop culture depictions of poker might think statistics and math is the only way to get ahead. But no, there's psychology too. Author Maria Konnikova took her Ph.D. in psychology to the poker table, and turned out to be good. So good, she went pro in poker, and learned all about her own biases on the way. We're talking about her new book "The Biggest Bluff: How I Learned to Pay Attention, Master Myself, and Win".
Now Playing: Radiolab

Invisible Allies
As scientists have been scrambling to find new and better ways to treat covid-19, they've come across some unexpected allies. Invisible and primordial, these protectors have been with us all along. And they just might help us to better weather this viral storm. To kick things off, we travel through time from a homeless shelter to a military hospital, pondering the pandemic-fighting power of the sun. And then, we dive deep into the periodic table to look at how a simple element might actually be a microbe's biggest foe. This episode was reported by Simon Adler and Molly Webster, and produced by Annie McEwen and Pat Walters. Support Radiolab today at Radiolab.org/donate.