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American Morning
Surgeons to Separate Pair of Twins Joined at Top of Their Heads
Aired August 05, 2002 - 10:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: At this hour in Los Angeles, surgeons are due to separate a pair of twins joined at the top of their heads. The skulls of the 1-year-old Guatemala girls are fused, and their faces are tilted in opposite directions, as you can see here on this videotape. Now, this is a risky surgery. It has been arranged by a nonprofit group, and it's expected to last at least 10 hours. And it's going to demand the skills of at least 50 medical workers that are working on this particular case.
And our medical correspondent Dr. Sanjay Gupta joins us now for a closer look at the procedure, the perils, and everything else involved here.
Heck of a story here.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: It really is. This is when the rubber hits the road, so to speak, in neurosurgery, Leon. Take you back for a moment, just a year ago, these babies were born July of last year in Guatemala, as you mentioned. The mom was in labor for eight days, Leon, and then the babies were taken nine and a half hours away.
At that point, an organization called "Healing the Children" out of Spokane, Washington actually intervened and brought these babies to the United States, to Los Angeles. They've already had one procedure that actually expanded some of the skin around their head. They are going to need that extra skin after this operation to cover up the new wound there, and now the 10 hour or so, probably even longer than that even, Leon, operation scheduled for today, basically to try and separate these twins.
This is one of the most intricate procedures in neurosurgery. Basically, one of the reasons is that these babies share about 10 percent of their brain tissue in common. Part of that is this big vein that actually drain the brain. Baby -- they are both name Maria. Maria number one's big vein drains into the back of Maria's number two's ahead. Maria two's big vein drains into the back of Maria number one's head. That's is going to be the real challenge of this operation. They certainly have a lot of resources. two neurosurgical teams, two reconstructive teams, five teams of anesthesiologists.
It's going to be a long day, but hopefully a successful one.
HARRIS: Yes. What do the experts say about handicapping this particular case?
GUPTA: Well, I'll tell you, these girls have already beaten the odds, so to speak, 40-60 percent of these babies are born stillborn. And of the ones that do survive, 35 percent don't make it past a year. So these have already beaten those odds.
It's hard to say, Leon. There's only been five of these procedures done over the last 10 years. So there's not a lot of data, really. But one thing we do know is that the surgeons are better today. They have better techniques. They have better resources. They also use this really complicated modeling system. They actually modeled both brains, including the veins together, and cost about 10,000 bucks to do that, but they will actually use that in the operating room as well to help guide the operation.
HARRIS: That's the other thing that fascinates me about this. I'm glad you are the one covering this for us, since this is your specialty, sort of neurosurgery. How do you decide, or how can you tell which part of that brain is which Maria's actual, I guess, brain that goes to each baby.
GUPTA: That's right. It is very complicated. And that probably is what makes it more complicated than anything else. These blood vessels. It's very hard to -- imagine a big tangle of blood vessels, and you have to sort of go through them, and decide which one goes where, but you can't cut any of them, because they're all pretty important. The risk of cutting them, certainly stroke, things like that, and that's one of the challenges.
I will say, statistically, you know, again, the numbers are small, but only 25 percent of the time have both twins survived. So the options here are: both twins are going to do great, one will have a neurological problem, or the other one, or one will die, and that's certainly a less desirable option.
HARRIS: Let me ask you another question, or am I getting too technical about it, the hooking of the blood vessels. That's got to be tricky enough, but what about the nerve endings themselves. If the blood vessels are performing some sort of a big nest, if you will, or a nexus up there, the nerve endings and that sort of thing will be even worse.
GUPTA: That's right. And 10 percent, as I mentioned, 10 percent of their brains are actually is common. They actually share that part of the brain, and it's going to be very technically challenging.
I will say this, believe it or not, being at the top of the head like that is a better place to actually have the brains actually connected. The neurosurgeons can with a little bit more impunity actually cut through some of that brain tissue. It sounds a little bit more gruesome than it is, but really, it's those blood vessels that are in between all that brain tissue. That ends up being the real challenge here, you know, again, because of strokes and things like that.
HARRIS: OK, so fine, the top of the head is the best place to have it, then which parts at the top of the head are the most at risk here?
GUPTA: The most at risk part of the top of the head is the back part of the head, and that's for a few reasons. One, part of your ability to have vision, that comes from there. And a lot of these blood vessels actually drain into that area.
Leon, if you have to cut one of these big blood vessels in the back of the head, you can drain -- a baby can drain their entire blood volume, all of their blood within 10 minutes. You can imagine the mood gets pretty tense. Things move quickly. You don't want that to happen, and that's what they're going to be avoiding today.
HARRIS: That's why they will be taking their time.
GUPTA: That's right, longer is OK in this case.
HARRIS: All right, good deal. Dr. Sanjay Gupta, thank you very much.
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