University of São Paulo: Technology in Siamese separation surgery places HC de Ribeirão Preto as a reference

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MA lot of technology in preparing for surgery and monitoring babies from pregnancy are the highlights of the most recent procedure by the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto ( HCFMRP ) at USP to separate the twins Mariah and Alana, aged 1 year and 7 months , who were born united by the skull.

This is the second case of Siamese separation that the HCRP performs. The first , unprecedented in Brazil, took place successfully in 2018, with the twins Maria Ysabelle and Maria Ysadora. As with their predecessors, Mariah and Alana underwent their first surgery, successfully performed on August 6, in which part of their brain veins were sectioned.

The process is carried out by a multidisciplinary team of 40 professionals from the HCRP and plans to carry out at least three more surgeries for the total separation of Mariah and Alana, which should only happen in a year, but the team’s work has already begun. for a long time, still in the prenatal period.

“The neonatal ICU took care of these children so that they could arrive in the good condition they are in now to undergo this separation process”, says Professor Ana Paula Carlotti, coordinator of the Pediatric Therapy Center at HCRP, who has accompanied the twins since birth. prenatal.

Alongside pre- and post-natal care, technological advances are also making a difference, believe the professors at USP in Ribeirão Preto, by allowing the team to study the surgical steps in advance. “These are surgeries that happen, oddly enough, before the procedure,” says Professor Hélio Rubens Machado, a neurosurgeon at the Department of Surgery and Anatomy.

“When we arrive at the operating room, we already know what we are going to do”, continues Machado, since the work begins with the images of the skulls, transformed into three-dimensional models, in a pre-surgical phase in which the team studies and plans the entire process in detail. .

These are images of tomography and magnetic resonance imaging of the twins’ skulls processed by specific software. The results of the exams “are dissected in detail and transferred to a 3D printer, which will produce what was the first great revolution in the treatment of these cases, which are the models”, says the professor.

These three-dimensional models allow the visualization and study of each of the veins that will be sectioned, helping the meticulous planning of each step of the separation. The technology that makes these models possible, says Machado, has promoted a gigantic change to make this type of surgery possible, by making it possible to handle the pieces as if they were the skulls themselves, being able to observe and choose “which veins [that will be separated]” , it says.

Favorable conditions for separation
The care that preceded the beginning of the surgical stage ensured “a good nutritional and physical condition”, says Professor Ana Paula. The twins were born “in a specialized service” and were followed up at HC Criança, with healthy food and growth, “to face all this challenge of the separation process”.

The same assessment is made by Professor Machado, who credits pre- and postnatal care for the big difference between the case of Mariah and Alana and other twins joined at the head. In the past, “these children did not have the chance to be born in good condition and did not arrive at centers like ours”.

Talita Francisco Ventura Sestari, the girls’ mother, says that her family, from the beginning, has been accompanied by “a wonderful team” that has been completely safe. “We are very confident in handing our daughters over to the entire team.”


Pre and postnatal care made all the difference between Mariah and Alana’s case and other twins joined at the skull – Photo: Disclosure/HC Ribeirão Preto

In addition to the anatomy, the separation procedures are decided together with the plastic surgery team, which plans “ the incisions that will be made in the girls’ scalps from the first surgery”, says Professor Jayme Farina, head of the Surgery Division. HCRP plastic.

According to Professor Farina, the skin “flaps” should cover the heads of the two girls at the end of the separation, without any damage to the fabric. ” From the beginning, you have to have this planning of the incisions so that there is no greater suffering from these flaps.” The team marks the location of the “future skin expanders”, installed “before the final surgery”, informs Farina. The technique is used so that children “gain more skin” and the top of the head is closed more easily.

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