Twins' Separation Procedure Hits Snag: Swelling in Girls' Brains Causes Doctors to Quit

Jun 08, 03:25 PM

Current Headlines: By Cheryl Powell, The Akron Beacon Journal, Ohio

Jun. 8--CLEVELAND -- Doctors at Rainbow Babies and Children's Hospital halted the first surgery to start separating 3-year-old twins joined at the head after discovering the girls' brains were swollen.

Surgeons closed the scalps and skull bones of Anastasia and Tatiana Dogaru without attempting to begin the separation process when efforts to reduce the brain swelling with medicines didn't work, Dr. Nathan Levitan, chief medical officer for University Hospitals Case Medical Center, said in a news conference Thursday.

In Wednesday's 11-hour procedure, Anastasia's blood pressure unexpectedly dropped -- another factor that convinced doctors it was too dangerous to continue, Levitan said.

"They felt that it would not be safe to cut into the brain tissue or the surrounding blood vessels in any way, without first understanding the cause of the swelling and the low blood pressure," he said. "As a result, they decided not to continue with surgery at that time."

Levitan said the girls were recovering well Thursday as doctors continued to determine when -- if ever -- the series of procedures needed to separate the twins could resume.

Doing fine

The girls' parents, Claudia and Alin, issued a handwritten statement Thursday indicating "Ana" and "Tati" are fine.

"We know that the doctors are being cautious to keep the girls safe," the couple said in their statement. "We want to thank you for your continued prayers."

The girls are to undergo more tests, including MRIs, to help the medical team figure out why their brains are swollen, Levitan said. A likely reason, Levitan said, is that the girls share a circulatory system.

Two previous non-surgical procedures to start separating their blood circulation by placing wire coils in their veins were successful and probably helped ease the swelling, Levitan said.

"It is entirely possible -- even likely -- that there has been increased pressure and possibly swelling all along in the brains of these girls," he said.

More, similar procedures might be needed before operations to separate the girls can be performed, he said.

A team of about 30 doctors, nurses and other medical personnel tended to the girls during the procedure.

Although doctors had to call off attempts to separate the twins, this week's operation wasn't a complete loss, Levitan said. The surgery was the first time the team could see into the girls' brain. "Our surgeons gained important information... that will facilitate their decision-making," he said.

The girls, born in Italy on Jan. 13, 2004, came to Cleveland on April 6 to begin the separation process.

High risk

Doctors acknowledge that the surgeries are extremely risky, carrying a high possibility that one or both of the twins might die.

But without surgery, the girls probably will die.

The girls' condition, known as craniopagus, is extremely rare, occurring in about one in every 2.5 million births. Only 10 percent of twins joined at the head live to the age of 10.

All along, Levitan said, doctors knew to expect the unexpected in the multistage separation process.

"We are all aware that these efforts of our physicians to separate these conjoined twins are largely unprecedented, due to the rarity of this condition," he said. "We are all aware that these efforts represent a long road with twists and turns, and unanticipated events can occur."

Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.

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