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Separating Saudi Craniopagus Conjoined Twins (Rana and Ranim)

A multidisciplinary team designated for the Saudi Craniopagus Conjoined Twins (Rana and Ranim) decided to perform a difficult and complex operation to separate the twins. The operation is scheduled to take place today, the 4th of May 2014 in King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh and is expected to last up to 18 continuous hours with a 60% success rate. 
 

The Head of the multidisciplinary team, Dr. Ahmed Al Ferayan, Consultant Neurosurgeon said that the Saudi twins (Rana and Ranim) were delivered via a Caesarean section at King Abdulaziz Medical City – Riyadh in August 2011. Since their birth, the twins were under special care undergoing multitude of tests including a Cerebral Arteriogram which showed that the extent in which the twins are conjoined is very high especially in the arteries of the brain.


Specialists found out that some of Rana's blood, flows back to Ranim's and vice versa. To decrease the likelihood of excessive bleeding, the final separation opertion was delayed in order to give the brain tissues more time to develop and grow.


Due to difficulty of this case, Dr. Al Ferayan noted that multidisciplinary team requested the assistance of Professor James T. Goodrich, Chief of the Division of Pediatric Neurosurgery in Montefiore Medical Center - Albert Einstein College of Medicine in New York.  Dr. Goodrich previously assisted the multidisciplinary team in the three operations prior to the final separating procedure. An expert in similar cases, he advised to configure a 3D model of the veins and arteries in the head and the brain as shown in the scans. The model was developed by a specialized medical company in order to assist in drawing up the surgical plan for separating the twins.


After comprehensively and thoroughly studying the twin's case from all angles, the multidisciplinary team concluded that the separation is possible through four stages.  The first stage started in April 2013 in which the veins between the twins' brains were severed and a slice of silicon was inserted between the two brains. This procedure was successful with no complications. A month later, the second stage was performed in which the remainders of the veins were separated along with separating a portion of the arteries that carry out blood from Rana's brain to Ranim's. This procedure was also successfully conducted with no complications. The third stage was carried out in October 2013 and was one of the most complicated of all three stages. The third part of the veins and arteries were separated along with a part of the shared brain, and a slice of silicon was inserted between the two brains.  The third phase was conducted successfully despite a temporary weakness Rana suffered in her right arm which was relived shortly after.
After the successful three stages,  the final stage to complete the separation of Rana and Ranim was scheduled to take place in May 2014.


The close-up monitoring of the twins continued and Dr. Riyadh Al Okaili, Consultant Neurointerventional Radiologist was able to ligate a large portion of the veins in the fourth part between the two brains. This is the first case in the history of separating a Craniopagus conjoined twins where a Neurointerventional Radiologist was able to ligate such veins through a catheter aiding in the final separation procedure and the formation of alternative veins between the two brains.

On this occasion H.E. Chief Executive Officer of Ministry of National Guard - Health Affairs and General Supervisor of Royal clinics, Dr. Bandar Al Knawy expressed his gratitude and appreciation to the Custodian of the Two Holy Mosques, King Abdullah bin Abdulaziz Al Saud for his directives and continuous support. Furthermore, he expressed his gratitude and appreciation to His Royal Highness Prince Salman bin Abdulaziz, Crown Prince, Minister of Defense and Aviation and His Royal Highness Prince Muqrin bin Abdulaziz, Deputy Crown Prince and His Royal Highness Prince Miteb bin Abdullah bin Abdulaziz, Minister of National Guard, for their continuous support.

Posted on 04 May 2014