Twin Girls Joined At The Skull Separated During 18-Hour Operation

Ervina and Prefina - happy and healthy - after their 18-hour operation. Ospedale Pediatrico Bambino Gesù

Doctors in Italy have successfully separated a pair of twins who were conjoined by the skull in what could be a world-first operation. 

Ervina and Prefina, now 2 years old, were born with their skulls joined back-to-back, one of the rarest and most complex forms of cranial and cerebral fusion known as “total posterior craniopagus.” They were born in a small village over 100 kilometers (62 miles) away from Bangui, the capital of the Central African Republic. Back in July 2018, the president of hospital Dr Mariella Enoc was on a mission in the country and came across the twins at the medical center where they were born.

On June 5, the twin girls were separated during an 18-hour surgery by a team of 30 doctors and nurses at Bambino Gesù Pediatric Hospital, a Vatican City children's hospital located in Rome, Italy. One month later, their doctors have declared the operation a success and say the pair are recovering well. 

The team claims this is the first time this specific operation has ever been pulled off, as operations on twins with total posterior craniopagus have not been previously described in the medical literature.

 Ervina and Prefina before their operation. Ospedale Pediatrico Bambino Gesù

The recent operation was the third and final procedure required to separate the pair. The initial part of the final operation involved physically separating the twins’ skulls and other tissues. The operation then continued in two different operating theaters with two separate teams working to rebuild the membrane that lines the brain of each twin. 

“It was an exciting moment, a fantastic, unrepeatable experience,” Carlo Marras, head of Neurosurgery of the Bambino Gesù Pediatric Hospital, said at a press conference. “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.”

The twins shared a large part of their skulls and their networks of blood vessels were deeply intertwined. To make matters even more thorny, one of the girl’s hearts pumped harder than the other, creating a complex difference in blood pressure between the pair. Fortunately, the twins were found to have good general health and typical brain function.

Despite sharing many similarities, their doctors remark that the pair are already showing different and distinct personalities: Prefina is playful and lively, while Ervina is more serious and observant. 

“Ervina and Prefina were born twice,” said the twins’ mother, Ermine. “My little ones can now grow up, study and become doctors to save other children.”

The pair had an exceptionally rare and complex case of total posterior craniopagus. Ospedale Pediatrico Bambino Gesù

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