Twin girls joined at the skull successfully separated in Vatican pediatric hospital

The medical team at Vatican’s pediatric hospital announced that they’ve successfully separated a pair of conjoined twin girls with an extremely rare congenital defect.

Ervina and Prefina Bangalo were born on June 29, 2018, in Mbaiki, Central African Republic. The twins’ heads were fused back-to-back, and they share critical blood vessels around their brains – a condition known as “total posterior craniopagus.” The babies’ case is so unique that it occurs only once in every 2 million births.

Mom and babies waiting for the operation to separate them at a pediatric hospital.
Courtesy of Bambino Gesu

On June 5, a team of 30 nurses and doctors performed the separation surgery, and the good news is that they are recovering well a month after the operation. In a video released by Bambino Gesu Pediatric Hospital, the babies can be seen waving along to music from their beds and clapping and holding markers. The hospital staff also sang them a happy birthday in Italian as they celebrated turning two years old last week.

Hospital president Mariella Enoc met Ervina and Prefina on a trip to the Central African Republic in July 2018. She offered to treat them in Rome, and the twins arrived in Italy in September 2018 together with their mother, Ermine Nzotto.

Courtesy of Bambino Gesu

Dr. Carlo Marras, the chief of pediatric neurosurgery at the hospital, said that the surgery’s main goal was “to obtain a separation with the girls in perfect condition. So the objective we gave ourselves was very ambitious, and we did everything to reach it.”

He led the team assigned to operate on the twins, and they spent almost two years planning and executing the separation. At a press conference held to announce the sisters’ surgery result, Dr. Marras said that the girls “can have a normal life” after undergoing a phase of rehabilitation.

Waiting for their surgery at a pediatric hospital.
Courtesy of Bambino Gesu

“We have been able to accomplish an extraordinary result despite such a complex malformation, being able to separate with an optimal clinical result. From a neurological standpoint, the two little girls are doing very well and have excellent prognosis for normal lives in the future,” he said.

The 18-hour surgery also made history, as it was the first time that doctors in Italy—and probably the world—did a successful separation of twins in total posterior craniopagus. There have been successful separation surgeries of twins joined in the head, but most have been for those whose heads were fused at the top.

The Bangalo sisters’ surgery was far more challenging, as the back of the head was a critical place for blood supply to the brain and drainage away from it.

A joyful mom at a pediatric hospital looking at her babies.
Courtesy of Bambino Gesu

Dr. Marras said that the most challenging aspect of the twins’ separation was giving each child autonomous venous drainage systems. This procedure began with two surgeries – the first one in May and the second in June 2019. The final 18-hour operation involved the use of 3-D imaging and neurostimulators.

Before the operation, members of the pediatric hospital gave the girls mirrors so they can see one another. According to Dr. Marras, although they knew what each other sounded like, a visual aid helped them associate facial expressions with their personalities and sounds.

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“It was an experience that wasn’t just professional but above all human: to think that you can arrive at something that we had only imagined, with all the possibilities of failure. It was a magical moment. Marvelous,” he said.

The only previously known case of a separation of twins conjoined at the back of the head was performed in the United States during 1987 – one that had a poor outcome. In the case of the Bangalo sisters, they haven’t manifested any neurological problems so far.

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Ermine Nzotto is overjoyed at the immense success of the surgery. As someone who never went to school, she has high hopes for her kids now that they have a chance at a normal life.

“It’s a joy, that I can see my girls run and play like other children. May they tomorrow study and learn to become doctors to save the other children of this world,” she said.

The mother thanked Dr. Marras, the pediatric hospital, and Pope Francis, who visited Bangui in 2015. She now hopes that her girls will be baptized by the pope.

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