Two Egyptian boys who were born joined at the head were lying in separate beds for the first time in their two years of existence on Monday, but doctors who worked 26 hours to separate them warned that they still faced a long road to recovery.
Separation of the twins was successfully completed at 11:17 am (1617 GMT) on Sunday, the Children’s Medical Centre announced, 26 hours after surgery began.
Plastic surgeons then worked another seven hours to close the wounds, grafting tissue taken from the boys’ thighs over the tops of the their skulls, which had previously been joined at the crown.
The infants, still heavily sedated, were listed in critical but stable condition after surgery was completed late on Sunday, but doctors warned of potential complications and a long road to recovery ahead.
“We’re very pleased with this outcome, but the post-surgical recovery determines the overall outcome,” said Dale Swift, one of five neurosurgeons who worked to separate the twins.
“We’ll be extremely concerned for them over the next few weeks. This is a long road.”
A waiting room packed with family and supporters erupted in cheers and tears when a nurse delivered the news shortly after 11 am: “we have two boys.”
The boys’ father “jumped up on my neck and he hugged me and he fainted,” said Nasser Abdelal, a pediatrician who had cared for the boys in Cairo and traveled to Texas with the parents for the operation.
“The mother on the other hand was crying, like everybody else, and she was there thanking everybody around and thanking her fate.”
Ahmed and Mohamed Ibrahim were born in a small town 800 kilometres south of Cairo in June 2001, then moved to the University of Cairo hospital.
The World Craniofacial Foundation of Dallas brought them to Texas in June 2002, according to the Children’s Medical Centre statement.
Doctors studied their case for more than a year before operating.
That preparation, including months of daily meetings spent planning the surgery and examining possible scenarios, paid off, surgeons said.
“Amazingly, it seemed to follow the plan fairly well,” Swift said of the all-night operation.
But the surgeons were surprised to find that the left hemisphere of Mohamed’s brain was tightly affixed to the right hemisphere of Ahmed’s brain. Peeling them apart proved to be the most challenging part of the operation.
“I hadn’t conceived it was going to be that difficult,” Swift explained.
Surgeons also painstaking separated a complex network of shared blood vessels between the two brains.
The boys will remain in a drug-induced coma for three to five days to reduce the potential for complications, doctors said. It will be days before doctors know if they suffered brain damage.
In the meantime they are at risk of strokes, brain swelling, infection, and fluid build-up.
“Most critical is the behavior of the wounds and how well they are going to heal,” said Bradley Weprin, another member of the neurosurgery team.
More than 50 doctors, nurses and staff participated in the marathon operation.
The team included two craniofacial surgeons, a pediatric plastic surgeon and an oral surgeon; nine anesthesiologists; six pediatric nurses; six surgical technologists; four respiratory therapists; and four anesthesia technicians, as well as engineers, pharmacists, clinical managers, pastoral care workers, social workers and translators.
Medical personnel contributed their time and local charities raised a $125 000 payment to Children’s Medical Centre for use of its facilities.
Companies donated three-dimensional models of the boys’ heads to help surgeons prepare for the operation and a custom-made operating table that rotated 360 degrees and split in two once the boys were separated.
Surgery would have taken much longer without the bed, doctors said.
Without the bed “we wouldn’t be having this conference today,” neurosurgeon Kenneth Shapiro told reporters after the separation. “We’d still be working.” – AFP