The Separation of Bangladesh Craniopagus Twins

blank blank Feb 16, 2020

[Photo above: Dr. Greg Pataki (left), the twins Rukaya and Rabeya, and Dr. Csokay (right)]

Dr. Csokay first met the twins back in 2017 where he was a part of a neurosurgical mission work in Dakha organized by Foundation of Defenceless People. The conjoined baby twins, Rabeya and Rukaya were well known in the neurosurgical world due to the underlying complexity and surgical efforts required for their separation. Unfortunately, due to life-threatening risks associated with the separation, no one attempted the procedure until Dr. Csokay, Dr. Greg Pataki, and their surgical team took on this challenge.

When he conducted his initial study of the twin’s MRI, Dr. Csokay himself had thought that it was impossible to separate them surgically due to a very complicated shared venous network. 

Since the tragic loss of his son six years ago to an accident, Dr. Csokay has become more devout to his faith and prayed many times when he faces great challenges. According to Dr. Csokay, he came up with an innovative solution that has never been used before for craniopagus twins after his 27th prayer. 

It was the multi-staged separation of shared veins by endovascular surgery. Dr. Csokay had never performed these modalities in his daily practice, but his friend, Dr. Stefan Hudak, who is a world-famous neuroendovascular surgeon, was able to conduct the complex procedure in 2018.

The 14-hour long three staged endovascular procedure and the successful separation of their shared venous network opened up the possibility of separating their brains and skulls. After continuous practice on a fresh cadaver (300 times) and studying 3D models (made by Kálmán Czeibert) of twin’s heads, and MRI tractography (planned by Dr. Istvan Valálik). This was then followed by seven-month-long plastic surgeries led by Hungarian plastic surgeon Dr. Greg Pataki on the twins, utilizing implanted expander to stretch the twin’s skin.

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Dr. Csokay (far right) with the surgical team and the patients

The final operation took place in Dakha, August of 2019. Dr. Csokay and his team collected 33 volunteer doctors and scrub nurses who participated in the operation. Tremendous support was shown by the locals and organizers of Dhaka and in Budapest towards Dr. Csokay and his team for the world’s first multi-stage separation of shared veins via endovascular surgery. Dr. Csokay believes he was able to push through this twenty-six long hour operation from the strength of his faith and prayers, and support of thousands of people from Hungary, Bangladesh, and Nigeria (where their previous neurosurgical mission took place back in 2016).

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3D printed conjoint twin anatomical model

“They were especially felt and needed in the last hours when I was near total exhaustion,” said Dr. Csokay

During the operation, both severe blood loss and life-threatening hypotension occurred. Several ICU specialists (led by Drs. Marcell Csapody, Erzsébet Ezer, Szenohradszky Katalin) performed excellent work to prevent further complications. In the postoperative course, vegetative disability almost caused the death of both children, who were also later threatened by infections.

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3D printed anatomical models of the twin’s intracranial vascular networks and the brain

As a result of everyone’s support and the phenomenal work conducted by the intensivists, the health of the children started to improve, and their neurological state became more stable. However, on the 33rd postoperative day, severe intracranial bleed occurred in one of the girls, threatening her life. Bangladeshi neurosurgeon Dr. Salek successfully removed the hemorrhage. However, this resulted in the worsened condition in one of the girls, who is yet to fully recover.

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Rukaya (left) and Rabeya (right) Dakha, Bangladesh

Rabeya is doing well (image above). She can walk, speak and her chances of a full recovery are very high. On the other hand, Rukaya who suffered severe intracranial bleeding has gained consciousness and is able to move her arms and legs, but she cannot walk. She is regaining her mental abilities much slowly. Due to Rukaya’s young age, Dr. Csokay is optimistic that neuroplasticity will help with her recovery. 

Both Rabeya and Rukaya are currently undergoing rehabilitation and are fully supported by specialists and their loving family in Dakha, Bangladesh.

About the Author:

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Dr. András Csókay studied at the Budapest University of Technology from 1975 to 1980, then graduated in 1980. He started his career as an engineer, changed his career after 3 years, and between 1983 and 1989 at the Semmelweis Medical University, he studied medical science in 1989 and then neurosurgery exam in 1994. From 1989 he became a specialist at the National Institute of Neurosurgery in Budapest, then from 1993 he worked at the National Institute of Accidents. From 2003 to 2007 he lived in Szombathely and worked in Neurosurgery at Markusovszky Hospital. He moved back to Budapest in 2007 and worked in the Department of Neurosurgery at St. John’s Hospital until 2009. From 2010 he became a member of the Neurosurgery of Miskolc County Hospital and started his neurosurgical career. 

He moved back to Budapest three years later and continued his career at the Honvéd Hospital on August 1, 2013, as Chief Medical Officer of the Department of Neurosurgery at the Hungarian Army Health Center, where he brought with him the two innovative surgical techniques he developed. tumor treatment technique. [3]

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