The neurosurgeons in Singapore who are trying to separate adult Iranian twins joined at the head were forced to slow their unprecedented surgery to a near halt last night as the pressure of the sisters’ brains on each other made the procedure harder than expected.
Moreover, the skull shared by Ladan and Laleh Bajani for the past 29 years proved to be much thicker than they had expected.
As the operation neared the end of its second day, the 28 doctors and 100 support staff at the Raffles hospital were more than eight hours behind schedule, and Operation Hope was expected to continue well into a third day, and possibly a fourth.
It has attracted such worldwide attention that the Iranian government announced yesterday that it would pay all the costs. Such surgery has never been tried before with adults and the chance of success is put at only 50%.
Raffles hospital said last night: ”Although the brains are distinctly separate, because they have been fused for the last 29 years they are very adherent to each other.
”Dissection to separate them is thus taking a long time because neurosurgeons have to carefully cut through the tissues millimetre by millimetre.”
The surgeons also found that the blood circulation between the twins was unstable, causing the pressure in the brains and the circulatory system to fluctuate.
”We anticipate that the process will continue well into the night and tomorrow, until such time as the surgeons can adequately separate the brains and ensure that the blood circulation is stable,” the statement said.
The hospital’s spokesperson, Prem Kumar Nair, remained optimistic last night. ”We hope that in the process everything still comes out fine,” he said.
The dissection began at 5pm yesterday, more than six hours behind schedule, mainly because of the unexpected skull thickness.
Just after midnight the operation entered what doctors described as the critical stage when neurosurgeons opened up the skull to expose the underlying brain and blood vessels.”
Dr Kumar said: ”This procedure took six hours, longer than originally expected, because the twins’ bones were found to be very thick and compact, especially in areas where the skull bones fuse.”
Before the dissection could begin the doctors had to reroute the shared main drain age vein from the brains. This was done by stitching a vein from Ladan’s right thigh to one of the twins’ brains to compensate for the removal of the shared vein.
Kumar refused to comment on earlier speculation that Ladan had received the grafted vein.
The spokesperson said the atmosphere in the operating theatre, where soothing classical music was playing most of the time, was ”calm and measured”.
”Nothing is going on at a hurried pace,” he said. ”There’s lots of discussion.”
The surgeons were not too worried by the delays yet, Kumar said, because the twins could be kept unconscious for at least four days.
Six foreign surgeons, including the world’s most experienced surgeon at separating twins joined at the head, Benjamin Carson, are on the team, which is led by a local specialist, Keith Goh.
The twins’ elderly parents, who have nine other children, are not with their daughters as they are too frail to travel, but dozens of friends and supporters have set up camp at the hospital, eagerly awaiting any scrap of news and holding a prayer vigil since the surgery began on Sunday.
The Iranian ambassador to Indonesia, Shaban Shahidi Moadaab, flew to Singapore yesterday and said his government would pay for the operation, which is expected to cost at least £180,000 ($295 880). – Guardian Unlimited