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(Reuters Health) – Twin babies meeting at the head who were separated on June 6, 2017 continue their recovery, one of them showing developmental delays compared to her sister, according to an update of the case that also provides details on the techniques used in the surgery.
The Philadelphia Children's Hospital surgical team used a 3D printer and special rings to gradually separate the brain from the girls before engaging in the 11-hour operation that gave Erin and Abby Delaney a life in the age of 10 months.
At 21 months, Erin could sit independently, verbally identify both parents, manipulate objects, and present normal muscle strength and tone. "It was expected that she would continue to follow a slightly delayed, but normally normal development course," reports the Philadelphia team in the New England Journal of Medicine.
Abby had more complications after the operation and "she was expected to have more neurocognitive problems than her sister, but she still had developmental gains," they write. She does not seem to be as ambidextrous as most children of this age, she was starting to sit independently and she had verbally identified a parent.
Lead author and neurosurgeon, Dr. Gregory Heuer, told Reuters Health during a phone interview that formal cognitive tests had not yet been performed, but "from the very beginning, which we are more concerned, it is the motor delays. Until now, they have exceeded expectations. They have this continued growth in their development. In fact, the twin who was a little behind his sister makes faster gains, which is a good sign for us. "
Abby's case was more complicated, in part because the girls shared a large vein that sends blood to the heart. But in his case, some of the deep veins that help to this end had reshaped to compensate.
The two girls are with their parents in Mooresville, Nc, just before Thanksgiving 2017. They continue to be followed by nutritionists, development pediatricians and other specialists.
A spokeswoman for the hospital was not able to estimate the cost of separating the girls.
The presence of twins in the lead occurs in 1 in 1.7 million births. Having the connection extend into the brain tissue is even rarer. The operation was performed before the girls' first birthday because the infant's brain tends to be more adaptable and regenerate better.
Prior to the separation operation, the surgeons cut the fused portion of the skull that joined the babies. They also created ring-like devices that went to their heads and gradually pushed girls out at a rate of 2 millimeters a day for several months starting at the age of 3 months. This technique also made it possible to reorient the girls, born inclined head, to straighten them and facilitate the operation.
Plastic models molded using 3D printing techniques helped Heuer and his team plan their surgery, including the fact that the twins shared this key blood vessel and a small part of the frontal lobe of the brain.
Heuer said that, in retrospect, he might have done different things, like moving the heads of the twins away more slowly.
"The problem is that each twin is connected in a different way, so some of the lessons we learned here will be applicable and others will not," he said.
In two or three years, girls will need more surgery to cover the openings in their skull that remain after the separation operation.
But even at this point, Dr. Heuer said, "their lives have changed and we are proud of them before they can ever hug or hug each other. I would like to think that this operation has had a significant impact on their lives, in the good sense of the word. "
SOURCE: bit.ly/2MqGb2D The New England Medical Journal, online 23 January 2019.
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