Twins Ervina and Prefina were born with their skulls joined and sharing critical blood vessels around their brains. Surgeons were determined to carry out the dangerous procedure and give the girls a normal life.
Surgeons successfully separated two-year-old twins with a rare congenital defect on Tuesday at a hospital in Rome. It is the first time such an operation had been carried out in Italy.
Twins Ervina and Previna's skulls were fused back-to-back and shared vital blood vessels — a condition that occurs around once in every 2 million births.
The 18-hour operation took place at the Vatican-owned Gesu Pediatric Hospital in Rome on June 5 and involved 30 doctors and nurses.
It was the final of "three very delicate operations," the hospital said in a statement on Tuesday.
"A month after the final separation, the twins are fine," it added.
The risk of infection was still present and the girls will have to wear protective helmets for a few months. After a rehabilitation phase, it is expected that the twins will go on to lead a normal life for girls.
Joined at birth
The two sisters, from Bangui, Central African Republic, were brought to Italy in September 2018 after the hospital's president saw the twins and their mother at a medical center where they were born.
Tests conducted in Italy showed the twins were healthy but that one sister's heart was working harder to maintain the "physiological balance of the organs of both, including the brain."
The twins' condition is known as total posterior craniopagus, which makes surgery particularly challenging due to the shared network of blood vessels that bring blood from the girls' brains to their hearts.
Three operations progressively reconstructed two independent venous systems, said the hospital in a statement.
In the final operation, the bones of the shared skull were divided. Then surgeons reconstructed the membrane covering the two brains and recreated the skin lining over the new skulls.
Neurosurgeons, anesthesiologists, neuroradiologists, plastic surgeons, engineers, and physiotherapists were involved in the process.
There have been successful separation surgeries in the past of twins joined at the head, but most have been for twins whose heads were fused vertically, at the top.
In the past 20 years in Europe, there have been only two successful operations separating twins joined at the top of their skulls.