Cairo Magazine - Delta medical drama

Little Manar has survived the operation and looks set for recovery.

When 29-year old Naglaa Mohamed delivered the first of her twin daughters last March after only 40 minutes, she may have thought that she was getting off easy. Her mind was changed by the doctor’s decision that the second would have to be delivered by Caesarean section, a grueling operation that took seven hours to complete. Four days later, however, doctors finally gave Nagla some troubling news—one of the twins, Manar, had an additional head that hadn’t developed a body.

Manar suffered from craniopagus parasiticus, a rare birth defect that occurs when a child’s skull is linked to the head of an undeveloped twin. The rudimentary head is usually called a parasitic head because it does not have an independent life. The incidence of craniopagus parasiticus cases represents 2 percent of all conjoined twins cases, which themselves only occur in 1 in 200,000 births.

On 19 February, Manar underwent a 13-hour skull separation and reconstruction surgery at Benha Neonatal Hospital, north of Cairo. A similar operation carried out a year ago by a team of American doctors in the Dominican Republic was unsuccessful. The American team attempted to operate soon after the birth, and the shock was too much for the newborn. The Egyptian team opted for a different approach.

“We had to wait several months before carrying the operation so that the baby’s body would become stronger and ready for any post-surgery complications,” said Dr. Naseef Hefnawi, director of Benha Hhospital and head of the 13-member surgical team. “The operation took a very long time because the doctors were trying to separate Manar’s brain from the conjoined head in small and slow stages.”

According to Dr. Muhammad Lotfi, head of the brain and nerve surgery department at Al Qasr Al Aini Hospital, it was major achievement. “The way we constructed the skull and cut off the blood supply is the first of its kind in the entire world and we are proud that the surgeons’ team was entirely composed of Egyptian doctors,” he told Cairo. “If things go well with Manar and she keeps on showing signs of improvement, it will be an unprecedented moment in the history of medicine.”

Manar, who has been in the intensive care unit since the operation, now has regular blood pressure and is moving all her limbs, a sign that there is no brain damage, according to the doctors at the children’s hospital in Benha. “She is fine now, and from time to time we switch off the ventilator. She has not suffered any complications but she will have her brain scanned after a couple of days,” said Dr. Abla Al Alfy, a consultant in pediatric intensive care and a member of the original surgical team.

Naglaa is confident now that her daughter will survive and continue her life as an ordinary child. “After all those months of pains, anxiety and tears, there is nothing like seeing your daughter breathing again and feel you will soon carry her home with you. I have great hopes in God’s will.”

Conjoined twins are formed from a single egg that develops into two almost separate units of cells. Dr. Bassem Ayoub, another member of the operation team, said the basic cause of the phenomena of conjoined twins remains unknown. “We have noticed that it happens in Africa more frequently than any other continent and we have had several cases in Egypt,” said Ayoub. “However, we have no clear reason for what happens. It could be related to the age of the mother, if she was on medication during pregnancy, how many times she was pregnant before and it could be something to do with air and food pollution. But we cannot confirm any of these hypotheses,” he told Cairo .

In the past 18 years, Egyptian hospitals have received 13 cases of conjoined twins. On 26 February, doctors at Alexandria Hospital announced that a 31-year-old mother had delivered triplets, with two of them joined at the stomach.