AIIMS doctor perform rare surgery on twins

In a first of its kind, AIIMS doctors recently operated upon twin babies suffering from craniosynostosis, a condition of early fusion of the skull sutures (specialized joints) leading to restriction in brain growth and cosmetic disfiguring.
Two brothers, Adhinath and Adhrinath (one-year-old), natives of Allepy district in Kerala, were admitted to AIIMS in March this year with cosmetic disfiguring wherein their head had got enlarged from front to the back and became smaller from side to side.
According to additional Professor of Neuro-surgery, Deepak Gupta, there are four major bones in the skull out of 22 skull bones and three major sutures in the skull, which start uniting in the second decade of life (between 10-20 years) and they close between 30-40 years of age but in these children, there was an early fusion of sutures and there was no space left for the brain to expand and grow.

After pre-operative planning of the surgery with 3D city scans and proper neuropsychological evaluation, both the kids were operated on March 27 at neuro sciences centre of AIIMS.
As the kids were born on the same day, the parents had requested that the surgery should be also done on the same day.
"The surgery is called cranial vault remodelling. As a part of the procedure, we took out all the four major bones of the skull (one frontal, two parietal and one occipital) and expanded them by multiple osteotomy in the skull bones and then placed them back in the skull which helped in reshapement offering larger space for the brain to grow," explained Dr Gupta.

The surgeries were challenging because the babies were young and they did not have enough blood. There is high risk of bleeding during such operations, hypothermia and air embolism which can be fatal.

After four hours of surgery on each baby, they stayed in the ICU for one day and were discharged seven days later.
The case was a rare one, said doctors, as they were monozygotic twins (originate from the same fertilized ovum) and had a rare blood group -- AB -ve.
According to medical literature, one of 5000 children suffer from craniosynostosis and there are higher incidences of craniosynostosis in twins.

In case of twin babies, there is less space for babies head inside the uterus and so there is an early fusion of sutures.
Delay in treatment leads to cosmetic deformity, delayed developemntal patterns and neuro-psychological abnormalities.
If left untreated, it could have raised intracranial pressure leading to headches, vomittings and loss of vision in the long run.