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American Morning

Doctors Work for Hours to Separate Twins

Aired August 06, 2002 - 07:28   ET

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

DARYN KAGAN, CNN ANCHOR: A team of doctors has been working through the night to separate two baby girls joined at the head. The girls were born in Guatemala. They were brought to UCLA Medical Center in Los Angeles for the surgery. It began about 14 hours ago. We're getting some conflicting reports on whether the surgery is over or not, but the issues that we're interested in remain the same.
And so we bring in Dr. Sanjay Gupta, who's been following the procedure, joining us from Atlanta -- Sanjay, good morning.

DR. SANJAY GUPTA, CNN CORRESPONDENT: Good morning to you, Daryn.

Yes, absolutely, the operation started about 4:40 Eastern time yesterday and it took about six hours to really get some of the bone around this obvious separation off, take that bone off. And then about six hours into the operation they started to actually look at the veins that we've been talking so much about, Daryn.

Basically, again, these veins are veins from one baby that actually drain to the other baby's head and the veins from the other baby drain into the first baby's head. And that was obviously going to be the most challenging part of the operation.

It has been over 20 hours now, not surprising that it's taking that long, with two teams of neurosurgeons, two teams of reconstructive surgeons, five teams of anesthesiologists. A long day, no doubt.

It appears to be getting close to the end, for sure. It doesn't sound like it's quite over as of yet. But that is the -- that is what we're hearing, as well.

Now, the possible outcomes, Daryn, obviously the best outcome both babies are not joined any longer and both doing well. Outcome number two would be that one has a neurological problem of some sort. Stroke is what they're most concerned about. Option number three, that they both have some sort of neurological problem. Or, four, that the operation is not successful. Or, five, obviously, that one or both of the twins would die.

That does not sound like it has happened. It sounds like the operation is going along very well at this point and it sounds like pretty close to being done.

KAGAN: Well, no one better than our own resident neurosurgeon here to explain to us exactly the risks that are involved. I was reading that the doctors had to tie off the veins in each baby's head very slowly, trying to get the blood to figure out, to kind of reroute in a different direction.

How risky and how difficult is that, Sanjay?

GUPTA: Well, I'll tell you, this is a really amazing thing, Daryn. Basically what you're describing there is that they actually, one vein going to the other baby, they're actually going to tie that off and see if the baby's own brain has enough veins, enough venous drainage to actually drain the blood without that big vein. And that is sort of the critical part.

Doing it slowly, just like you said, Daryn. They actually put some clips on the veins very slowly to see if the baby's brain will be able to tolerate that. And if it does, that makes the operation go along at a much more rapid pace.

If the baby does not tolerate that, then the surgeons are faced with trying to figure out how else they're going to drain the brain of blood without that major vein. And that is the trickiest part of the operation.

The risks of not doing that well, the risks of closing up that vein too quickly and the risks of that blood accumulating within the brain is basically a stroke. Sometimes those strokes can be very, very devastating. And that's exactly what they're trying to avoid, in a very intricate sort of way.

KAGAN: And what about the positives here? These are clearly alert, otherwise healthy little girls. What about the benefit of being healthy 1-year-olds and how the brain tissue regenerates and the kind of brain surgery that you can do and chances that you can take on a child that wouldn't work as well in an adult?

GUPTA: That's an excellent point, and, you know, babies are very resilient to this sort of thing. A couple things to keep in mind. The brain continues to develop for quite some time. These babies' brains are going to develop for a while. So even the dissection between the two brains, that area of the brain should regenerate.

Also, you know, the size of the head continues to grow till about two years and then it stops. Babies' heads are usually about full size, adult size, that is, at about 24, 28 months. But that's good news because in terms of the skull, where there's obviously some gaps in the skull, that's all going to remodel well. What wee did know is that these babies were very, very normal. They developed normally in terms of their intelligence, in terms of their milestones, things like that.

So if this operation is successful, we should have two healthy, happy babies.

KAGAN: And that's what we're hoping for. We're still waiting from Los Angeles.

Dr. Sanjay Gupta, our own resident neurosurgeon, thank you for your insight.

GUPTA: Thank you.

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