Twins Born Joined at their Heads are Surgically Separated

The twins were joined at the tops of their heads, so that they were facing away from each other. They shared a brain cavity and their brains had fused partially. The hundreds of intermingled blood vessels in their brains made the surgery especially challenging. Neurosurgeon Keith Goh characterized the intertwined vessels as "torturous routes up a mountain." Another challenge was identifying and trying to preserve the speech and logic centers in each girl's brain. Although it was impossible to avoid some damage to the brains, surgeons did not want to injure these crucial areas. At this point, doctors do not know if either girl will have functional problems as a result of the surgery.

A team of 20 doctors took shifts, operating for almost four days. At any one time, there were up to 16 doctors in the room. The surgeons had expected the surgery to take about 40 hours but the surgery took much longer because every blood vessel had to be traced and separated. One consulting surgeon described the blood supply as looking like a "tangled serving of spaghetti." The surgery was finished by plastic surgeons who closed the skulls. Gortex, a synthetic material used in raincoats, was substituted for the dura, a tough tissue layer that covers the brain. Surgeons patched parts of the infants' skulls with a mixture of tiny bits of bone and a strong glue. Both girls will have to go through more plastic surgery in the future.

It is too soon to tell if the girls have any neurological damage. The biggest risk right now to the girls' recovery is infection and hydrocephalus, a condition in which the production and/or drainage of cerebrospinal fluid (CSF) is disrupted and too much fluid accumulates in the brain. The girls will probably stay in the hospital for the next three months. As of Monday, April 16, 2001, when doctors took off the girls' bandages, each girl had a fever and a high white blood cell count, both signs of infection. Doctors are pleased with the girls' progress, however, and optimistic about their recovery.

The doctors prepared for six months before the actual surgery. They practiced "virtual surgery" with a three-dimensional imaging system using pictures of the girls' skull cavities. The "3-D" images were made using already existing brain imaging technology: magnetic resonance imaging (MRI), computed tomography (CT) and angiography. A computer program then combined the images from the three scans into one three-dimensional image.

Conjoined twins are rare, but ones joined at the head are extremely rare, occurring approximately once every two million births. The first successful separation (meaning no neurological damage) of twins joined at head was performed in 1987. In the past 500 years, only about 80 cases of conjoined twins joined at the head have been known worldwide.

Back home in Nepal, relatives gathered around their neighborhood's only phone, waiting for news. Having been told that the babies had a 50-50 chance of surviving the surgery, the family is calling the promising outcome a "miracle." As medical technology advances, perhaps more miracles will be possible.

References:

1. "Siamese Twins Successful Separated," by Dean Visser, Yahoo Daily News, April 10, 2001.
2. "Different rooms at last as surgeons separate twins," April 10, 2001.