VizDExter 3D imaging system enables successful brain separation of Siamese twins

Singapore 14 April 2001At the Singapore General Hospital, a team of 20 doctors worked around the clock for four days to separate the fused brains of twin sisters Ganga and Jamuna Shrestha. Their success depended on virtual reality software, developed in Singapore, which allowed the surgeons to see inside the girls' shared skull, months before the operation. The 11-month-old girls were born joined at the head, their brains twisted around each other. Only a handful of doctors have tried to separate this type of Siamese twins, and fewer have succeeded.


To prepare for the rare surgery, Dr. Keith Goh, the director of the medical team which separated the girls, used virtual reality technology to see inside the girls' entwined brains and plan his moves. The three-dimensional imaging system, known as VizDExter, was designed by researchers from the National University of Singapore and first used by Johns Hopkins University in Baltimore.

Johns Hopkins opened a clinic and research centre in Singapore in 1999, its first health care facility outside the United States. Dr. Benjamin Carson, an expert in Siamese twins who are joined at the head and the chief paediatric neuro-surgeon with Johns Hopkins, consulted with physicians in Singapore before Ganga and Jamuna's surgery. He was one of the first doctors in the world to use the 3D imaging system developed at the National University of Singapore.

The 3D VizDExter simulator allows physicians to see inside brains or other organs in virtual reality. Wearing 3D glasses, doctors can use the VizDExter to manipulate digital photographs. "It looks like you've taken a brain out and you're holding it in three-dimensional space", as Dr. Benjamin Carson stated.

A team of twenty doctors worked around the clock in shifts for four days to separate the twins, with between 14 and 16 doctors in the operating room at any given time. Their surgery took so long because the girls shared hundreds of blood vessels and doctors had to cut through the tangled maze to separate them. The girls were born in a poor, mountainous village in Nepal with parts of their brains merged, a rare condition known as craniopagus.

The twins could suffer brain damage, according to the doctors. They also face risks of brain swelling and infection and will have to remain in intensive care for at least two weeks, Dr. Goh explained after surgery. Dr. Benjamin Carson of Johns Hopkins University Hospital confirmed the greatest post-surgery risks the twins faced were infection and fluid in the brain cavity. The girls will equally need complex skull reconstruction and possibly more plastic surgery. Ganga has a cleft palate and will likely have it corrected at some stage.

The high-profile surgery to separate the Siamese twin girls cast a spotlight on Singapore's efforts to become a world hub for scientific research. The government has earmarked $571 million as seed money for this scientific research in the private sector. Educators and scientists in Singapore work closely with John Hopkins University Hospital in Baltimore. Singapore's trade and industry minister, George Yeo, called the Siamese twins' surgery "historic" for the city-state. "It helps to position Singapore in the region.", the minister stated.

"One part of the operation which gave us pride was the use of the 3D virtual reality simulator without which the operation would never have been performed", Minister Yeo explained and he added that in his old job as Health Minister, he saw digital hearts and brains Singaporeans had made in collaboration with Johns Hopkins.

Singapore hailed last year's mapping of the human genome as a golden age of life sciences. Education Minister Teo Chee Hean stated that grade school students would learn about biotechnology, that the ministry would recruit more biology teachers, and establish links with universities abroad. Mr. Yeo said creating a life sciences hub "goes way beyond" health care, adding that Singapore aims to become a centre of genomics as well as of the manufacture, testing, and designing of drugs.

Leslie Versweyveld

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