In a landmark surgery, doctors at AIIMS have managed to separate twins, Jaga and Baliya, who were joined at the head since birth.
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Both are critical but stable, AIIMS director Dr Randeep Guleria told TOI on Thursday, hours after the twins, aged two years and five months, were shifted to the ICU. "The next few days are crucial for their survival," he added.
A team of 20 surgeons and 10 anaesthetists started the process to separate the twins at around 6 am. Both Jaga and Baliya, who underwent the first phase of the separation surgery on August 28, were wheeled into the operation theatre and anaesthetised. At 9.30am, neurosurgeons started to separate their brains along with the blood vessels. The two were finally separated at 8.45pm. It took another four to five hours to cover their brain.
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One of the babies was shifted to ICU at 11.45 pm and other baby at 2.30 am, doctors said. Twins joined at the head are rare, occurring once in 25 million live births; it is even rarer for them to share the vein carrying blood back from the brain to the heart. Worldwide, there have been very few successful surgeries to separate such twins.
"Our team has achieved a milestone. But there are many more roadblocks ahead in the path to their complete recovery. We have to keep our fingers crossed," Dr A K Mahapatra, chief of AIIMS' neurosciences centre, said.
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When the twins were referred to AIIMS for separation, doctors said Jaga was healthier and they believed chances of his survival were better as compared to Balia. However, during the treatment, he developed heart complication. Balia, too, has kidney malfunction. "It is difficult to predict the survival chances. We as doctors have done our best and will continue to do so," Dr Manish Singhal, professor of plastic and reconstructive surgery, said.
While the surgery to separate the two took nearly 20 hours, doctors told TOI they spent several weeks planning for the same. "We practised the surgery 3D print model several times before the actual surgery. It helped us understand the vessel anatomy and how to cut the brain precisely," said a doctor, who did not want to be quoted. He added there were several nervous moments in the run-up to the surgery.
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"One of the kids had multiple episodes of seizures. But when we gave medication to control the same it didn't help initially because the venous channel in the brain was shared. We had to double the dosage," Dr Shefali Gulati, a child neurologist at AIIMS said.
The twins, doctors said, played happily before the surgery and pulled each other's hair even. "Their innocence worked to our advantage. Had it been an adult patient, convincing them for multiple surgeries taking as long as 20 hours would have been difficult and they would be psychologically impacted too," said a doctor. But even for Jaga and Balia, doctors said, the fight for life is far from over.