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Topic: Conjoined twins undergoing separation (Read 230 times)

MzWings
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Conjoined twins undergoing separation
« on: Jul 6^th, 2003, 5:19pm »

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I don't know how many of you are following this amazing and critical story but I am. Surgery began early this morning and will last from two to four days. Both of these women know that one or both could be damaged or die but they don't want to live the rest of their lives being joined at the head(s).

God bless....

http://www.foxnews.com/story/0,2933,91164,00.html

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Re: Conjoined twins undergoing separation
« Reply #1 on: Jul 7^th, 2003, 11:23am »

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(CNN) -- A risky operation to separate two Iranian sisters joined at the head entered its second day Monday, with doctors performing the unprecedented surgery trying to split and reroute a large vein that serves the adult twins' brains.

A spokesman at Singapore's Raffles Hospital said 29-year-old Ladan and Laleh Bijani were in stable condition. The operation, which began Sunday, is expected to last two to four days.

The surgery involves an international team of neurosurgeons, dozens of doctors and support staff.

Early Monday, surgeons began the crucial blood vessel work. The sisters have separate brains, but the brains share one major vein. Apart from being joined at the head, the sisters have distinct bodies.

Doctors have harvested a vein from Ladan Bijani's right thigh to be used as a new blood vessel for one of the sister's brains.

"It is probably one of the most critical aspects of the surgery," said hospital spokesman Dr. Prem Kumar Nair. "As we have said before, the key component in Laleh and Ladan's surgery is the shared blood vessel."

Nair said that the operation schedule was a few hours behind but that everything had been going as planned.

"We haven't really met any problems so far, but I would anticipate that the next 12 to 24 hours will be a very critical period and that may be where we will have to traverse some possible difficulties," Nair said.

The operation could be fatal to one or both of the twins. The sisters, both law graduates, said they were willing to accept the risks and face those dangers to lead separate lives.

Doctors previously told the twins in 1996 the shared vein made the procedure too dangerous.

Landmark procedure for adults
Singapore doctors performed a similar operation in 2001 on infant Nepalese girls, but an operation on adult twins is unprecedented.

The operation is more difficult in adults than in children, who have more recuperative powers.

A friend of the twins kisses them before their operation.
Twins joined at the head are the rarest of conjoined twins, occurring one in every 2 million births. Twins joined elsewhere occur once in every 100,000 births.

In a statement, Raffles Hospital said it is the first facility in the world to attempt a surgical separation of adult twins joined at the head.

Dr. Keith Goh, a neurosurgeon who operated on the Nepalese twins last year, is leading the operation on the Bijanis, along with Walter Tan, the hospital's medical director, the hospital said.

Specialists in neurosurgery, plastic surgery, radiology and anesthesia also are involved, along with experts from the United States, France, Japan and Switzerland.

The Bijanis' operation is considered elective because the women likely would live a normal life span without it.

However, testing has shown the sisters have high intracranial pressure, which, if untreated, could cause frequent debilitating migraines and impaired vision as well as deteriorating brain function, the hospital said.

Laleh Bijani already suffers from chronic headaches, the hospital said.

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azure
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Re: Conjoined twins undergoing separation
« Reply #2 on: Jul 7^th, 2003, 12:28pm »

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God Bless them

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azure
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Re: Conjoined twins undergoing separation
« Reply #3 on: Jul 7^th, 2003, 12:57pm »

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‘While we are cautiously optimistic, there are some twists and turns that we will have to navigate.’
— DR. PREM KUMAR

AN INTERNATIONAL TEAM of five neurosurgeons successfully attached a vein graft before beginning the process of separating the brains of 29-year-old Ladan and Laleh Bijani in the unprecedented operation expected to last up to four days, a Raffles Hospital official said on condition of anonymity.
Doctors were not going to cut through the twins’ fused skull bone and move their heads apart for the first time until determining that the vein graft was successful and making sure that there were no connections between the brains that escaped notice in pre-operative exams.
The women’s brains touch inside their skulls, but going into the operation doctors did not believe the brains were joined. The sisters’ bodies are otherwise distinct.
Rerouting the shared vein was considered the biggest obstacle in the surgery.
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German doctors told the twins in 1996 that the vein, which drains blood from their brains, made surgery too dangerous.
“There may still be some difficulties encountered, but up until now we are quite satisfied with the progress of the whole surgery,” hospital spokesman Dr. Prem Kumar said Monday.
“They are stable, the anesthesia is working quite well, so we are cautiously optimistic.”
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 Bijani sisters said they would rather face those dangers than continue living joined.
Before dawn, surgeons began stitching a vein taken from Ladan Bijani’s thigh to one of the twin’s brains to compensate for the removal of the shared vein, Kumar said. He would not say who received the original, finger-thick shared vein.

Classical music played softly as surgeons worked simultaneously in tight spaces in front of and behind the twins, who are sitting in a custom-built brace connected to an array of lines feeding them intravenously and monitoring their vital signs, Kumar said.
“Nothing is going on at a hurried pace,” he said. “Everything is quite calm and measured. There’s lots of discussion.”
Surgeons had earlier encountered unexpected delays cutting through their skulls when the bone turned out to be denser than previously believed, Kumar said.
“The procedure took six hours — longer than originally expected — because the bones were thick and compact, especially in the areas where the two skull bones fuse,” Kumar said.
The twins spent months training at a gym to build up strength for the surgery and Kumar said they could be kept asleep for four days if necessary.
The twins said they wanted to walk into the operating room as a sign of courage, but they were brought in by wheelchair because they were too tired to stand, Kumar said.
Participating neurosurgeon Dr. Benjamin Carson, the director of pediatric neurosurgery at Johns Hopkins Children’s Center in Baltimore has successfully separated three sets of craniopagus twins — siblings born joined at the head.
However, this is the first time surgeons have tried to separate adult craniopagus twins. The surgery has only been performed successfully since 1952 on infants, whose brains can more easily adapt and recover.

Doctors work to separate Iranian sisters
July 6, 2003 — Two adult sisters from Iran -- joined at the head -- are undergoing surgery to be separated. But NBC’s Don Lemon reports the procedure also carries with it the ultimate risk.

“If God wants us to live the rest of our lives as two separate, independent individuals, we will,” Ladan Bijani said before the operation.
The Bijani sisters were born in Firouzabad in southern Iran in 1974. In a statement read on state-run Iran television late Sunday, President Mohammad Khatami hoped for success.
“The prayers of the Iranian nation are with you,” Khatami said in a message addressed to the medical team. “I hope to see my patient daughters Laleh and Ladan healthy and fresh as soon as possible.”
An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery.
Also Monday, the Iranian government said it would cover the nearly $300,000 cost of the surgery and care for the twins. Earlier, Raffles Hospital offered to underwrite the cost of the operation and doctors offered to waive their fees.

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Re: Conjoined twins undergoing separation
« Reply #4 on: Jul 7^th, 2003, 6:57pm »

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SINGAPORE — Neurosurgeons (search) separating 29-year-old Iranian sisters joined at the head cut through brain tissue millimeter by millimeter Tuesday after rerouting a thick, shared vein and stitching in a new one.

http://www.foxnews.com/story/0,2933,91164,00.html

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Re: Conjoined twins undergoing separation
« Reply #5 on: Jul 8^th, 2003, 5:20am »

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Second Iranian Twin Feared Dead After Surgery

SINGAPORE (Reuters) - A second Iranian twin died soon after her conjoined sister passed away on Tuesday during unprecedented high-risk surgery to separate their heads and brains, hospital sources and friends of the women said.

"She has died," an Iranian woman close to the twins said. "It's a mess up here and we're trying to calm down." A hospital nurse also told Reuters of the second death.

If confirmed, the deaths of 29-year-old Laleh and Ladan Bijani would bring to a halt two days of surgery by a team of 28 specialists and 100 assistants, who had pried apart the women's tightly packed brain tissue and blood vessels at Singapore's Raffles Hospital.

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Re: Conjoined twins undergoing separation
« Reply #6 on: Jul 8^th, 2003, 8:16am »

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SINGAPORE - Laleh and Ladan Bijani, 29-year-old conjoined twins from Iran, died Tuesday shortly after neurosurgeons separated them in the third day of surgery.

In their homeland, people cried out in shock or wept as Iranian state television broke into normal programming to announce their deaths on the operating table in Singapore.

"Is my beloved Ladan really not with us anymore?," Zari Bijani, an elder sister of the twins, said after Ladan's death was reported. Seconds later, she fainted.

The Singapore hospital announced Ladan's death first, then, a few hours later, a nurse involved in the surgery said her sister Laleh had died.

"Everyone upstairs is crying," said the nurse, speaking on condition of anonymity. "We treated them like family because they had been here for seven months."

Earlier, doctors said Ladan died after they were unable to stabilize her condition.

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

The risky, marathon separation procedure began about 10 p.m. EDT Saturday. Before the operation, doctors warned that the surgery could kill one or both of the twins, or leave them brain-dead.

It was the first time surgeons 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.

The brains of Ladan and Laleh Bijani were separate, but were nonetheless stuck together after years of lying alongside each other.

Kumar had warned that controlling the bleeding and moving the twins from a seated position onto separate beds would be the biggest challenge, and that the condition of either twin would remain largely unknown until they wake up after surgery. The twins were seated during the operation.

As one of the final points of the separation procedure, surgeons cut a finger-thick shared vein from Ladan — leaving her to rely on a similar sized vein taken from her right thigh that was grafter to her brain.

Rerouting the finger-thick shared vein, which drained blood to their hearts, was considered one of the biggest obstacles in the surgery. German doctors told the twins in 1996 that shared vein made surgery too dangerous.

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.

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."

Dr. Marc Mayberg, chairman of neurosurgery at the Cleveland Clinic in Ohio, had said by telephone the pressure fluctuations could be fatal.

Although the sisters knew the operation could kill one or both of them, they decided to face those dangers after a lifetime of living conjoined and compromising on everything from when to wake up to what career to pursue.

"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.

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.

_____

Editor's Note: Emma Ross, an AP medical writer, contributed to this story from London; AP writer Ali Akbar Dareini contributed from Tehran.

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MzWings
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Re: Conjoined twins undergoing separation
« Reply #7 on: Jul 8^th, 2003, 9:06am »

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What a sad end for these valiant young women. They knew their chances of living through this surgery were next to nil, but were willing to risk their lives rather than being forever conjoined.

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Re: Conjoined twins undergoing separation
« Reply #8 on: Jul 8^th, 2003, 10:29am »

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I feel horrible for the families of these ladies.

Poor things, had it hard their whole livesd and now what a tragic ending Cry

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Re: Conjoined twins undergoing separation
« Reply #9 on: Jul 8^th, 2003, 1:46pm »

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how incredibly sad. while i understand the desire for a life lived on your own and could never understand what they had gone through joined, i, too, feel for their family and their grief, pain and loss of not one but two beautiful people. Cry

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Re: Conjoined twins undergoing separation
« Reply #10 on: Jul 8^th, 2003, 6:31pm »

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yup.... that was a very sad news this morning for me... Sad

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MzWings
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Re: Conjoined twins undergoing separation
« Reply #11 on: Jul 8^th, 2003, 6:55pm »

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I have a feeling it will be a very long long time (if ever again) that adult acute cranial disconjoinery will be attempted. On the other hand, these two vital women aided in pioneering such a task for surgeons - all over the world.

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Re: Conjoined twins undergoing separation
« Reply #12 on: Jul 8^th, 2003, 7:16pm »

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yes..and though it might be easy for us to say that we wouldn't have taken the chance...we weren't living as they were. Can you imagine a life where you can't have any time privately to yourself...where every life choice must be shared with someone else...and already one of them was starting to have headaches..it would not have been long for the other one to start by the sounds of things...I think I would have taken the chance..in fact I'm sure I would have...

Rest in Peace to two very brave ladies!!

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