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Jose Jones
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http://www.cnn.com/2002/HEALTH/08/06/conjoined.twins/index.html
Miraculous': Doctors separate conjoined babies
'Now we're keeping our fingers crossed'
LOS ANGELES, California (CNN) --In a marathon operation, more than 50 doctors and nurses at Mattel Children's Hospital in Los Angeles on Tuesday successfully separated 1-year-old twin girls joined since birth at the tops of their heads.
Dr. Michael Karpf, UCLA Medical Systems vice provost, described the operation as very successful. "We have to take things one step at a time, certainly the next few days are very critical," Karpf said. "The surgery was very successful, and now we're keeping our fingers crossed."
The babies have been removed from the operating room and are breathing on ventilators, Karpf said. The infants were in the operating room being prepared for surgery for almost 6 hours before the separation procedure, which lasted about 15 hours.
"This is as difficult as it gets." Karpf said. "We are all relieved and pleased that, so far, they have done as well as they have."
UCLA medical student Houman Hemmati was in the operating room when the Guatemalan twins were separated. He said the mood in the operating room became tense as doctors neared the most critical part of the separation.
When the infants were finally pulled apart for the first time in their short lives, people in the room were "crying, cheering, screaming, you name it, and when that was done, we paused, looked at twins, and really appreciated what we'd just done," Hemmati said. "It was miraculous."
Extra skin created
The babies, Maria Teresa and Maria de Jesus Quiej-Alvarez, were wheeled into the operating room Monday at 8 a.m. (11 a.m. EDT), but the surgery did not begin until 1:49 p.m. after anesthesiologists put in breathing tubes and intravenous lines to deliver blood and medication, and arterial lines to measure blood pressure.
Using extra skin created over the past month through a skin expansion procedure, UCLA's plastic and reconstructive surgery team then created the skin flaps that were to be used to cover the top of the brain of each child.
On June 24, doctors inserted balloons under the girls' scalp and then injected small amounts of saline into them over time, stretching the skin so they will have enough to cover the wounds once they are separated.
By 5 p.m. Monday, neurosurgeons had removed a strip of bone about two-thirds of the circumference of the shared skull to expose the brain and the veins of the twins.
They were investigating the vein connection between the brains and attempting to separate the brains.
As of 6 p.m., surgery was progressing as planned and expected to last at least another 10 hours, the hospital said.
The team is composed of neurosurgeons, plastic and reconstructive surgeons, anesthesiologists and nursing support staff.
Doctors said that in some respects the girls are lucky: Tests showed they have separate brains normal in size and structure and separated by a membrane, meaning surgeons would not have had to cut through any brain tissue. And the arteries that carry blood to their brains are also separate, doctors said.
But the veins that drain blood from their brains are crisscrossed and will have to be rerouted, a procedure that carries the risk of stroke, doctors said.
Help from nonprofit group
The girls were born July 25, 2001, after their mother underwent an eight-day labor near their home in rural Guatemala. They weighed 4.4 pounds together. Their mother is a homemaker, their father a farm worker.
A Spokane, Washington-based nonprofit organization called Healing the Children arranged for the girls and their parents to be flown to Los Angeles.
Doctors think that conjoined twins are caused when the single egg that would normally divide into two in the case of identical twins does not wholly separate. As a result, some of the body parts are fused, according to experts.
In 40 percent of cases, conjoined twins are stillborn. Another 35 percent of them survive until their first birthday.
In only about 2 percent of cases are the twins joined at the head.
Because such cases are so few, statistics about success rates of surgery to divide them do not exist.
Although the operating room personnel were donating their services, the procedure will still cost about $1.5 million, the hospital said -- beyond the resources of the girls' parents. The hospital has established a fund to recover expenses.
Miraculous': Doctors separate conjoined babies
'Now we're keeping our fingers crossed'
LOS ANGELES, California (CNN) --In a marathon operation, more than 50 doctors and nurses at Mattel Children's Hospital in Los Angeles on Tuesday successfully separated 1-year-old twin girls joined since birth at the tops of their heads.
Dr. Michael Karpf, UCLA Medical Systems vice provost, described the operation as very successful. "We have to take things one step at a time, certainly the next few days are very critical," Karpf said. "The surgery was very successful, and now we're keeping our fingers crossed."
The babies have been removed from the operating room and are breathing on ventilators, Karpf said. The infants were in the operating room being prepared for surgery for almost 6 hours before the separation procedure, which lasted about 15 hours.
"This is as difficult as it gets." Karpf said. "We are all relieved and pleased that, so far, they have done as well as they have."
UCLA medical student Houman Hemmati was in the operating room when the Guatemalan twins were separated. He said the mood in the operating room became tense as doctors neared the most critical part of the separation.
When the infants were finally pulled apart for the first time in their short lives, people in the room were "crying, cheering, screaming, you name it, and when that was done, we paused, looked at twins, and really appreciated what we'd just done," Hemmati said. "It was miraculous."
Extra skin created
The babies, Maria Teresa and Maria de Jesus Quiej-Alvarez, were wheeled into the operating room Monday at 8 a.m. (11 a.m. EDT), but the surgery did not begin until 1:49 p.m. after anesthesiologists put in breathing tubes and intravenous lines to deliver blood and medication, and arterial lines to measure blood pressure.
Using extra skin created over the past month through a skin expansion procedure, UCLA's plastic and reconstructive surgery team then created the skin flaps that were to be used to cover the top of the brain of each child.
On June 24, doctors inserted balloons under the girls' scalp and then injected small amounts of saline into them over time, stretching the skin so they will have enough to cover the wounds once they are separated.
By 5 p.m. Monday, neurosurgeons had removed a strip of bone about two-thirds of the circumference of the shared skull to expose the brain and the veins of the twins.
They were investigating the vein connection between the brains and attempting to separate the brains.
As of 6 p.m., surgery was progressing as planned and expected to last at least another 10 hours, the hospital said.
The team is composed of neurosurgeons, plastic and reconstructive surgeons, anesthesiologists and nursing support staff.
Doctors said that in some respects the girls are lucky: Tests showed they have separate brains normal in size and structure and separated by a membrane, meaning surgeons would not have had to cut through any brain tissue. And the arteries that carry blood to their brains are also separate, doctors said.
But the veins that drain blood from their brains are crisscrossed and will have to be rerouted, a procedure that carries the risk of stroke, doctors said.
Help from nonprofit group
The girls were born July 25, 2001, after their mother underwent an eight-day labor near their home in rural Guatemala. They weighed 4.4 pounds together. Their mother is a homemaker, their father a farm worker.
A Spokane, Washington-based nonprofit organization called Healing the Children arranged for the girls and their parents to be flown to Los Angeles.
Doctors think that conjoined twins are caused when the single egg that would normally divide into two in the case of identical twins does not wholly separate. As a result, some of the body parts are fused, according to experts.
In 40 percent of cases, conjoined twins are stillborn. Another 35 percent of them survive until their first birthday.
In only about 2 percent of cases are the twins joined at the head.
Because such cases are so few, statistics about success rates of surgery to divide them do not exist.
Although the operating room personnel were donating their services, the procedure will still cost about $1.5 million, the hospital said -- beyond the resources of the girls' parents. The hospital has established a fund to recover expenses.
