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Successful Separation of Craniopagus Conjoined Twins (Rana and Ranim)

The multidisciplinary team, medical and surgical, successfully completed the separating operation of the Craniopagus Conjoined Twins (Rana and Ranim) early Monday morning 05/05/2014.

The operation lasted for Eighteen hours and was considered a major challenge to the capabilities of the Saudi medical team due to the complexity of the case and the extent in which the twin’s heads were conjoined. 
      
 
The multidisciplinary team consisted of more than 30 specialists and doctors who are some of the most prominent Saudi consultants in King Abdulaziz Medical City, Ministry of National Guard - Health Affairs in  Riyadh.

The Separating operation was performed throughout eight stages. The first stage started by putting the twins under anesthesia and placing in all the needed catheters. Headed by Dr. Nezar Al Zughaibi, Pediatrics Anesthesiology Consultant it was scheduled to last 3 hours but was completed in an hour and ten minutes. Participating in this stage were consultants Dr. Adnan Koumi, Dr. Mohammed Gomaa and Dr. Ahmed Al Ferayan, Neurosurgery Consultant and Head of the multidisciplinary team.

The Second stage lasted three hours and covered preparing and prepping the twins for  radiological mapping. This stage was performed by neurosurgeons: Dr. Ahmed Ferayan, Dr. Merdas Al Otaibi, Dr. Moutasem Azzubi, Dr. James T. Goodrich, Director and Professor of the Paediatrics Neurosurgery Division -   Children’s Hospital at Montefiore, Albert Einstein College of Medicine in New York, Dr. Manaf Al Azzawi, Consultant, Plastic Surgery Division and Dr. Nasser Al Hodaib, Consultant, Division of Plastic Surgery
 
Neurosurgeons carried out the third stage by cutting the skin and removing some tissue expanders through the the Craniotomy.

In the fourth stage, the two brains were separated from one another along with the delicate veins and arteries via microscopic separations. This stage lasted for four hours and was performed by Neurosurgery Consultants: Dr. Mahmoud Al-Yamany, Dr Ali Bin Salamah and Dr. James T. Goodrich in addition to Dr. Ahmed Al Ferayan.
      
 
The surgical team then proceeded onto the most crucial and difficult fifth stage. This stage included separating the skull's posterior wall after turning the twins over to get to the other side of the head. Separating the remainder of the attached and portion of the brain,  the twins were completely separated from one another. This stage was performed by neurosurgery consultants and a number of plastic surgeons; namely, Dr. Ahmed Al Ferayan, Dr. Merdas Al Otaibi, Dr. Moutasem Azzubi, Dr. Mahmoud Al-Yamany, Dr. Ali Bin Salamah and Dr. James T. Goodrich.

In the sixth stage, the surgical team divided into two sub-teams, one with each of the twins. This stage included the reconstruction of the dura mater for both girls. While in the seventh stage skull reconstruction was done by both neurosurgeons and plastic surgeons.
The final stage had the team of neurosurgeons, with the support of the plastic surgeons, closing the wounds and placing the bandages.

Upon completion of the operation, the separated twins were transferred to the Pediatric Intensive Care Unit for recovery and observation.

Posted on 05 May 2014