“She sometimes talked to herself but when we spoke to her she didn’t always reply,” says Zainab.For the first time in their two years of life, the survival of each sister is no longer dependent on the other.
But the team relied on more than 1.3 million pounds (more than $1.6 million) invested in the past six years into Great Ormond Street’s craniofacial surgery program and research.Safa and Marwa Ullah’s condition was extremely rare.
All that remains is to push the putty-like brains the last couple of centimetres into the newly divided skull cavities.There are two theories about why they are fused together - either the split into two embryos happens later than usual, and the twins only partially divide, or, following the split, parts of the embryos remain in contact and those body parts merge as they grow.Their father Abdel-Majeed Gaboura is a doctor at a local hospital. This is the moment of truth and everything has to be perfect," says Dunaway. Meanwhile, a second team, led by Dunaway, has set up shop a few feet from the main action.Over the next seven hours, the remaining connections of bone, brain and tissue are severed, until just one piece of dura, the membrane around the brain, links the sisters.“I am very happy. “There is so much we don't know about conjoined twins, we think we're doing it the right way but we really need to understand that in a scientific way.”“However, the true reason for me helping them was because it was an operation that was going to save the lives of two children. But there has been no mention of where on their bodies the join might be.Safa and Marwa’s particular commingled physiology presents a unique set of challenges for the GOSH team. Each twin supplies the other with blood.
He keeps repeating the same word: "Incredible."Jeelani adds: “We have taken the twins apart, but now we have to reconstruct their heads, and put each of them back together.”The anaesthetists call out commands, report vital signs and busy themselves trying to stabilise the girls. Pads are attached to Marwa’s chest in preparation. "We have been through everything in fine detail - rehearsed it repeatedly. For the first time in their lives they will be able to see each other.Moving smoothly, every motion calculated. Every severed connection runs the risk of causing a stroke in one of the twins. The Gaboura sisters have had one of the most successful outcomes of any separated craniopagus twins.
And that's pretty difficult to do just in your head." It is the twins' grandfather Mohammad Sadat Hussain who finds out the truth first - the girls are what is called craniopagus twins, which means they are joined at the head. The team has been preparing for this day for months. Rital and Ritaj are evidence of what can be achieved for craniopagus twins, if the surgery is done at a young age when the body’s regenerative powers are strongest. She gave me my phone and said: 'Call David'.He remembers the moment they arrived: “They turned up in early August and at this point we only had a small amount of the money we needed.
Every time a connection is cut, there is a risk of brain damage.
She is delighted that we are where we are. “The idea is that we will gradually inject the tissue expanders and they will blow up like a balloon and the skin over the top of them will stretch.”She says she instantly fell in love.No-one, it seems, realises the full extent of the complications to come.“It may have been difficult to provide the care to keep them fit and healthy.
Two months before the birth, Zainab’s husband died of a heart attack.As the parallel operating rooms are prepped for the final stage, the two lead surgeons, smiling broadly, shake hands in the corridor outside.“A piece for me, piece for you, piece for me, piece for you," says Dunaway, a veteran of 23 years in plastic and cranio-facial surgery, making two piles of skull fragments.Standing 7ft high, the operating microscope dominates the theatre. There is still a long way to go but they are making progress and starting to regain their former playfulness.But this is no routine operation. He is told that Safa is in trouble, making no effort to breathe and her skin is mottled.Once the shared arteries are separated, the skull frame is re-attached.
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