Craniopagus Twins
11–29–16, Adil
So you’ve heard of conjoined twins that have to share their bodies. But how much do you know about craniopagus twins?
About 10–20 of every million births in the US involves conjoined twins, and about 2–6% of those are craniopagus. Craniopagus twins are conjoined at the head. So they have more bodily freedom compared to some other types of conjoined twins, but most spookily, they sometimes share parts of their actual brains.
One of the most famous examples of craniopagus twins is that of Kristina and Tatiana Hogan:
These young girls, alive and well at age 10 in Canada, do indeed share parts of their brain(s). Specifically, they share their thalamus. The thalamus is a crucial relay station in carrying neural signals from the body to the brain. A shared thalamus has spooky effects. For example, when Krista drinks juice, Tatiana can actually feel it coursing through her body (though of course there is no juice in her body). Again, this is because they share a thalamus — the signals that go to the actual drinker’s brain are also experienced by the non-drinking twin. Other examples: when one is tickled, the other jumps; when one took a pacifier, the other would stop crying too. Maybe most strikingly, the twins can actually see through each other’s eyes — if you cover up one twin’s eyes and show an object to the other twin, the blinded twin can tell you what it is. Video of all this here. Definitely recommend checking it out just to even see how they walk around. It’s also really cool to see how the two girls are developing different personalities.
One caveat to their surprisingly normal health: Tatiana’s heart has to supply not only her own brain, but also her sister’s — of all the blood that goes to Krista’s brain, about 20–25% of it is motored by Tatiana’s heart working extra hard. This gives Tatiana high blood pressure, but it’s being managed well by medications.
There are other examples, too. Only about 25% of craniopagus twins actually survive significantly past birth. Separation efforts are made yearly, but in some cases (like that of Tatiana and Krista), the family elects not to attempt this risky surgery. In several attempts, one or both twins has died, become paralyzed, or suffered compromised neurological function. The oldest craniopagus twins alive today are Lori and George Schapell, who are age 55 and living in Pennsylvania.
Clearly evident from the picture above, the twins are very different heights — Lori is 5'1" but George is only 4'4" because he suffers from a separate physical condition called spina bifida, which causes growth restrictions and limits his mobility. Driven by his own need, he invented the specialized wheelchair that he now uses. He has also designed specialized wheelchairs for other handicapped people (unsure of details here).
Craniopagus twins are born with the same sex, but in 2007 George said he identified more as a male and thus changed his name (formerly Reba). George has performed extensively in America and abroad as a country singer, even winning an LA Music Award for Best New Country Artist in 1997.
Apparently Lori even pays to attend George’s concerts, just like any other fan, and makes a conscious effort to be “invisible” during his performances. Complementing her twin’s talents, she is a trophy-winning bowler.
Okay, cool. Now let’s talk separations.
As I hinted earlier, they are highly risky and not always successful. The first time craniopagus twins were separated and one actually lived was 1952 with the separation of 11-month-olds Rodney and Roger Brodie in Illinois. Both twins actually survived the surgery itself, but Roger died 34 days later, having never regained consciousness. One reason for this was that, during surgery, doctors discovered that the twins actually shared the critical blood vessel in the brain responsible for draining blood from the brain to the heart (@Leif: the sagittal sinus) — however, only Rodney could really retain the vessel after surgery. Rodney recovered, albeit with some neurological damage. His skull was never closed (tech limitations, I imagine…?), so he wore a helmet until his death at age 11.
One of the most famous separation cases is that of Zambian twins Joseph and Luka Banda. They were born in 1997 and operated on that same year by yours truly… Ben Carson. Admittedly in extremely badass fashion, he led a team of 50 Zambian and South African specialists to separate the 11-month-old twins in a 28-hour operation. (He was in South Africa to receive an honorary degree when he was asked to check out the twins.) In 2001, the separated twins got retrofitted with new, artificial skulls to permanently close their heads. They are neurologically intact and living in Zambia. This is the case that Carson gets all the hoopla about (and rightfully so). It was the first time Type 2 craniopagus twins (joined at the head and facing in opposite directions) were successfully separated. To be clear, though, there were several other head separations before and after this famous one.
This was Carson’s only true separation victory, though; 4/5 attempts he was involved in (not always the sole leader) were much less successful. First, in 1987, he led a surgical team of 70 members in trying to separate seven-month-olds Patrick and Benjamin Binder. There weren’t many follow up reports after the surgery, but two years after the operation, “both twins were reportedly ‘far from normal’ […] with one in a vegetative state. ‘I will never get over this . . . Why did I have them separated?’ said their mother, Theresia Binder, in a 1993 interview. Neither twin was ever able to talk or care for himself, and both would eventually become institutionalized wards of the state. Patrick Binder died sometime during the last decade, according to his uncle, who was located by the Washington Post in 2015.”
In 1994, Carson was in South Africa for another separation. These twins were born in the rural village of Lebowa where such twins were seen as signs of witchcraft; had the parents tried to raise their kids in that village, the parents could very well have been burned at the stake, as dozens of people are every year in Lebowa. So, raising them there wasn’t really an option. After a 20-hour operation, it turned out that one twin had all the cardiac function and the other had all the renal function. Both died.
In 2003, Carson was part of the team that attempted separating 29-year-old Iranian twins Ladan and Laleh Bijani. Their lives are pretty amazing stories (born to a farming family, lost in a hospital when doctors had to flee to the US during Iranian revolution, found several years later by parents in a different city, but they had been adopted by and chose to stay with another doctor). Ultimately, they decided to try for separation so late because of personal reasons; Ladan wanted to pursue a career as a lawyer and Laleh as a journalist. They had previously compromised and settled on Ladan’s preference, thus studying law for four years at Tehran University. Later, though, they wanted to move to separate cities for study and work. Additionally, they wanted children. So they gave surgery a shot. The Bijani twins had a case of a fused brain like the Hogan sisters; both died on the operating table within 90 minutes of each other because of too much blood loss.
In 2004, Carson led a 100-member team in separating Lea and Tabea Block. With surgeons rotating through 4-hour shifts to stay fresh, the operation still stretched over five days. Eventually, Tabea started failing, and she died during the operation. Lea is now 12 years old and speaks reasonably well, but she is blind and has trouble walking.
All in all, really wild stuff. Holla if you have any questions — happy to do further research. I love this stuff.
Footnote: WTF is this picture with white-coated Ben Carson and Jesus?? I kid you not, this picture is hanging in his home. What a bizarre human being.
Source for the unlinked stuff above:
