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CNN Live Today

Interview with Dr. Michael Karpf

Aired August 06, 2002 - 10:01   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

LEON HARRIS, CNN ANCHOR: Now, up first this hour on CNN, we are going to get the latest on the conjoined twins who are now recovering from the grueling surgery that took place yesterday to separate them. We are going to begin with some medical perspective, and for that, we are going turn to our colleague, Medical News Correspondent Dr. Sanjay Gupta.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Quite a story.

HARRIS: Yes. A lot has happened since you and I talked here, what, almost exactly 24 hours ago.

GUPTA: That's right. So just to bring everyone up to speed, and we have got a guest as well, 4:49 Eastern time yesterday, the operation began. Within five to six hours, they had a good portion of the bone removed around the twins' head. A few hours after that, they started to look at these veins. Leon, we have been talking a lot about these veins, and we are going to talk more about that.

But before we do, why don't we bring in Dr. Michael Karpf from UCLA. He actually has some news, has something to bring us up to speed on -- Dr. Karpf, welcome.

DR. MICHAEL KARPF, VICE PROVOST, UCLA MEDICAL SYSTEMS: Good morning.

GUPTA: What news do you have for us? What is going on there in Los Angeles now?

KARPF: Well, the children are now out of surgery in the pediatric intensive care unit, and so things are going quite well, and we have our fingers crossed. We're certainly still in very critical phase.

GUPTA: Great. So the operation itself, the separation procedure, from what we understand, actually finished a few hours ago and now they are actually out of the operating room. Is that right? Are they off the ventilators and everything, awake?

KARPF: No, they are out of the operating room. I don't think they are off the ventilators just yet, that will be a while, but they are out of the operating room, and they are in the pediatric intensive care unit.

GUPTA: Dr. Karpf, the big question, I think, on everyone's mind is really how are they going to do. They were under anesthesia for about 20 hours. Can you give us a sense, like in the next couple hours, next couple of days, how things are going to progress now?

KARPF: I think we have to take things one step at a time. Certainly the next several days are going to be very critical with these children. We have cases that go as long under anesthesia, but this was very complex, and it will take days for everything to sort out. We just take things one step at a time. Surgery was very successful. And now we just hope -- do our very best and keep our fingers crossed.

GUPTA: Everyone defining it as successful. Dr. Karpf, one of the big things that they were concerned about was strokes from actually manipulating these blood vessels. Any sense from talking to the surgeons in the operating room that anything untoward happened, or anything unexpected happened like that?

KARPF: No, the separation went very well, the blood vessel separation and the venous drainage went very well. So at this point in time, there is no indication of any problems with that. We will have to wait until they fully wake up until we see what happens over the next couple of days, but as I said, so far, so good, and the surgeons are very pleased with the separation.

GUPTA: You know, they always talk about something not being brain surgery. In this case, it clearly is brain surgery. But give us a sense, Dr. Karpf, how difficult is this, even in the scheme of brain operations? This is one of the tough ones, I hear.

KARPF: Well, this is almost unique surgery. It is the first time we have done it. It has been attempted only a few times, so I guess this is about as tough as they get.

GUPTA: You know -- and I'm a neurosurgeon, Dr. Karpf, but one of the things, walking into an operation like that, was this -- what were the surgeons -- were they optimistic, were they confident about this? They had never done it before.

KARPF: No, they hadn't done it before, but they had studied these children very carefully. They had made models. We had tremendous amounts of information. We took a long time making sure it was appropriate to try this. So they were very confident when they walked in. But as you well know, until you get into the operating room, until you see what you find, you are never a hundred percent certain, so we are all relieved and pleased that so far, things have done as well as they have.

GUPTA: And I guess one last question. I know you are involved with the administration as well at UCLA. Give us a sense of how much this is going to cost, overall, the operation, to take care of these kids afterwards, the whole thing. Give us a sense of that, and where is the money coming from?

KARPF: Well, this will be, potentially, as much as a million or a million and a half dollars when all is done, and clearly, we have had some philanthropy, some people have donated. UCLA will take ultimate financial responsibility for this if insufficient money is raised. So it is a major commitment. But we felt because of the unique skills that we had, that if these kids were going to have a chance, it was going to be here.

GUPTA: Great. Dr. Karpf, thank you so much. Appreciate your time.

KARPF: OK.

GUPTA: Healing the Children, Leon, that was the organization, actually out of Spokane, Washington, flew these kids up from Guatemala.

HARRIS: I'm kind of glad you asked that question. I had been wondering about how this -- how it was going to get paid for, how much it cost, that sort of thing, but I let the doctor handle that one.

GUPTA: That's right.

HARRIS: But let me ask you something real quickly since you have got the...

GUPTA: Yes.

HARRIS: ... you have got the model here with you.

What I am totally fascinated by is what happened with the veins we were talking about yesterday here. You said there was a vein, a large one that drains the blood away from the brain, and as I understand it now, there was -- the big question was about whether or not they would be able to either reroute them or fix it somehow...

GUPTA: That's right.

HARRIS: ... that each brain would get the proper drainage.

GUPTA: That's right.

HARRIS: Can you give us...

GUPTA: Yes.

HARRIS: ... explain here what happened.

GUPTA: Yes. In fact, let me show you an X-ray first. This X- ray actually demonstrates quite a bit of what we are talking about here. And you can see here, Leon -- let me just orient you. What you are looking at sort of is one head at the bottom that is actually facing to the right, and so you see the eye ball, actually, there as well. Then you see a black line sort of in the middle of the picture, Leon.

HARRIS: That runs almost like a diagonal from the top right to lower left.

GUPTA: That right. That's right. And that's actually the separation of the two brains here. But you get a sense of how connected these brains were. And in that black line that you are seeing there, that is where this big vein runs. Let me show you the model now, Leon, that you talked about, and the model here, as you can see, if we can get a picture of that...

HARRIS: Here we go.

GUPTA: ... basically what you are going to see is -- this is the vein here, I am going to point to it with my pen. And instead of going down to the back of the brain where it should have continued, it actually went over here to the other baby's brain.

HARRIS: Got you.

GUPTA: And what this is representing is actually the vein from the other baby's brain, instead of continuing on in just her brain, it actually went to the first baby's brain back here. So they actually had to disconnect these two veins, and that was the critical part of the operation, actually clipping these veins off and making sure the brain could tolerate that well, not having a stroke, things like that, and that was the most challenging part of it.

HARRIS: And you know what I also can't figure out, is where does the material come from to create the covering of the skull? Because as you see, there wasn't enough to -- I don't know, fold the skull over there. How do you handle something...

GUPTA: That is an excellent question, and a good point. One thing I will point out as far as the skin goes, they actually put some tissue expanders underneath the skin even a month ago to sort of slowly expand the skin. Why? So that you have extra skin to cover it. Now, as far as the bone goes, a couple of interesting things. First of all, a one-year-old baby will continue to model bone for up to a couple of years. They may actually produce some of their own bone. The other thing they will do, which is fascinating, they will actually take some existing skull and actually split it, so that skull, where it was taken from, is actually half the width, and they use the other half to actually cover the new defect.

HARRIS: Once again, explain this one for the uninitiated. When you say split it, do you mean like shave it in half?

GUPTA: Yes, shave it in half, so you literally get two sort of thick pieces of skull, half the thickness they used to be, but enough to still cover something up. They may also use some cadaveric bone, bones from cadavers, to sort of cover that up as well.

HARRIS: All right. So once they do something like that, and the girls stay in intensive care or whatever, what kind of protections do you have to put in place to make sure they don't do anything to damage all that?

GUPTA: Well, they probably going to have little head wraps on, and things like that. They will heal amazingly quickly, actually, from something like this.

HARRIS: Because they are so young?

GUPTA: Because they are young and because their body will continue to remodel that bone very quickly. Kids are so resilient to things like this, even a big 20-hour operation like this they tend to do rather well. But you know, Leon, it is a good point, though, still, it is just right after the operation. A couple days, a couple of weeks, even, before we really know how they did. Are they going to have full strength, are they going to have full speech, are they going to be developmentally the same. It is going to take some time. Can't make -- I don't think anybody can make those predictions right now.

HARRIS: Yes, but they should be able to get out and play like any normal child sometime soon.

GUPTA: They probably be doing it a lot quicker than anybody expects, I imagine.

HARRIS: That would be great. That would be fantastic. You know what...

GUPTA: We will get you pictures, if they are doing that, for sure.

HARRIS: There you go. That's one of the home movies we want to see here, that is for sure. As I understand it too, we are also trying to see if we can get some pictures of them while they are in the hospital.

GUPTA: That's right.

HARRIS: Once we do get some, we will show them to you folks at home.

GUPTA: Yes.

HARRIS: Thanks, doc.

GUPTA: Good seeing you, Leon.

HARRIS: Sure do appreciate it.

GUPTA: Yes, absolutely.

HARRIS: Good work there. Thank you for explaining that for us.

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