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(Ram - Lakshman)
(Veena - Vani)
  Anjali- Geethanjali
(Xiphi-Omphalo Pagus)
  Rekha - Surekha
(Ischeo-pagus. Tetrapus)
Ram-Lakshman (Craniopagus – Fronto Frontoparieto temporal):
Born on 13th June 1990 after a caesarian section delivery at Gudivada, Krishna Dt., were admitted to children surgical services at Guntur Medical Collage Hospital at 20 hrs of age (3.5 kgs).

During the hospital stay they had few problems (Gastro – Enteritis,URI, Pyrexia; and Skin infections) which were adequately treated. They were monitored closely for behavioral problems, response of one baby to stimulus & illness of the other and the like. Routine Investigations & CT Scan were done and it was found that the fusion was mostly bony and the membranes covering brains were fused with minimal vascular communications, (cross – circula- tion).

First Stage surgery (introduction of Sialastic Tissue expanders) was done on 12th October 1991 at the age of 1 yr. 4 months. The sialastic tissue expanders were inserted one in either baby in the subgaleal layers of scalp under general anesthesia.

This procedure helped to know a bit about cross-circulation, extent of bony fusion and feel of the future problem i.e., separation of twins. The skin expanders were slowly expanded with 600-700 cc of saline over a period of 3 months.

Final Separation was done on 1st February 1992, and itlasted for 7 ½ hrs. The fusion was mostly osseous with a few vascular communications and fused layer of meninges common to both babies. After the separation one baby was left with common dura and a small bony defect and the other without any meninges. This defect was covered with proline mesh. Complete skin cover was possible in both babies. Postoperative recovery was uneventful in both babies and were discharged home after a total stay of 20 months in the hospital. These kids (Ram & Lakshman) are being followed up and are now 16 yrs old, attending school with normal mental caliber.
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