Conjoined Twins die in surgery

[southsider2k5]

Neurosurgeons separated 29-year-old Iranian twins joined at the head Tuesday after two days of delicate surgery, but both sisters died shortly after their parting.

 

THE HOSPITAL announced Ladan Bijani’s death, then, a few hours later, a nurse involved in the surgery said her sister Lelah had died.

“Everyone upstairs is crying,” said the nurse, who was directly involved in the operation. She was speaking on condition of anonymity.

“The second one has died,” she said. “We treated them like family because they had been here for seven months.”

Hospital officials had yet to officially announced the second death. Earlier, they announced the death of Ladan Bijani, saying she had lost a lot of blood as the two-day surgery was coming to a close.

Surgeons began a marathon operation to separate the twins on Sunday afternoon — warning that the operation could kill one or both.

It was the first time surgeons had attempted to separate adult craniopagus twins — siblings born joined at the head — since the operation was first performed on infants in 1952.

 

UNSTABLE PRESSURE LEVELS

“As the separation was coming to a close, a lot of blood was lost. The twins were subsequently in a critical state,” said hospital spokesman Dr. Prem Kumar.

The team of doctors had to contend with unstable pressure levels inside the twins’ brains just before they worked to uncouple the sisters’ brains and cut through the last bit of skull joining them, Kumar said.

 

On Monday, the team of doctors completed one of the most dangerous steps in the surgery by rerouting a shared vein and stitched in a new one. The shared vein, thick as a finger, drained blood from the twins’ brains to their hearts.

The sisters’ brains had “to be teased apart very slowly,” Kumar said. “Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues.”

He said surgeon worked “millimeter by millimeter.”

The operation was complicated further when the team discovered that the pressure in the twins’ brains and circulatory system was fluctuating.

 

FACING THE DANGER

Monday’s rerouting the shared vein was considered one of the biggest obstacles in the surgery. German doctors told the twins in 1996 that the surgery was too dangerous, but the Singapore team benefited from technological advances, Kumar said.

It was known that the operation could kill one or both of the sisters, but after a lifetime of compromising on everything from when to wake up to what career to pursue, the sisters said they would rather face those dangers than continue living joined.

“If God wants us to live the rest of our lives as two separate, independent individuals, we will,” Ladan said before the operation.

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The Iranian government said Monday it would pay the nearly $300,000 cost of the operation and care for the twins.

 

This is the first time surgeons have tried to separate adult craniopagus twins - siblings born joined at the head. The surgery has been performed successfully since 1952 on infants, whose brains can more easily recover.

Participating neurosurgeon Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children’s Center in Baltimore, has separated three sets of craniopagus twins.

Because this operation is a medical first, surgeons have encountered unexpected obstacles not seen in infants. It took longer to cut through portions of their skulls because their older bones were denser than previously believed, Kumar said.

As the procedure dragged on, surgeons tried to get adequate rest, slipping out of the operating room for breaks when their expertise was not needed, Kumar said.

Classical music played softly as surgeons worked simultaneously in tight spaces in front of and behind the twins, who sat in a custom-built brace connected to an array of lines feeding them intravenously and monitoring their vital signs, Kumar said.

The sisters were born into a poor family of 11 children in Firouzabad, southern Iran, but grew up in Tehran under doctors’ care.

As girls they used to cheat on tests by whispering answers to each other, they told reporters last month.