Introduction: Countries with limited resources have real difficulties in separating craniopagus
twins. Separation surgery cannot be considered there due to lack of technological
conditions and appropriate means. Objective: To show the benefits of an Italian-Central
African humanitarian collaboration, after two years follow-up, aiming to improve
the first childhood years of craniopagus twins, born in the Central African Republic
and separated in Rome. Case Report: The two female conjoined craniopagus
twin, born at term on June 29, 2018 in Mbata located about 96 km from Bangui (CAR),
were referred to the neonatology unit of the CHUPB on their 3rd day of
life. The mother was 31-year-old, gravida 4 and para 5. Prenatal cares were quantitatively
and qualitatively poorly followed. The diagnosis of posterior conjoined craniopagus
twins associated with early neonatal infection was retained. After seven days of
antibiotics and regression of infectious symptoms, the newborns were kept in the
neonatology unit for a closer follow-up, pending the completion of administrative
procedures for a medical evacuation as part of the international humanitarian activities
of the Pediatric Hospital of the Holy Seat in collaboration with the Pediatric Teaching
Hospital in Bangui. Finally, the twins were transferred to the Bambino Gesu Hospital
in Rome on September 10, 2018 where the 3D images confirmed the total posterior
fusion. Between May 2019 and June 2020 thirty hours of interventions allowed a step-by-step
separation of the twins, with a gradual rerouting of the shared blood supply, remodeling
and re-creating a skin to cover the skull bones. No postoperative complications
were recorded; the twins recovered satisfactorily after 6 months of separation and
are awaiting discharge at their origin country where the CHUPB team will continue
monitoring. Conclusion: The successful separation
of total posterior craniopagus twins remains historically scarce and the guarantee
of success has been based on detailed and well planned surgical management.
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