20-hour operation seperates twins

Surgeons have successfully separated Siamese twins who were joined at the head.

A team of specialist doctors in Los Angeles worked for more than 20 hours to separate brain tissue shared by the year-old girls in one of most rare and complex operations yet undertaken.

Maria Teresa and Maria de Jesus Quiej-Alvarez were born with their heads fused and their faces pointing in opposite directions. They shared a vein and an important cavity in their brains which could have caused potentially fatal strokes or brain damage had surgery not gone to plan.

Dr Houman Mennati, who led the surgical team, said there was "absolutely no major trouble" during the operation. He added: "Everyone had goosebumps at the end of the procedure. People were cheering, people were clapping, people were crying. We can't wait until we see these kids playing, laughing, crying like normal babies."

One of the girls lost a lot of blood during surgery but was given a transfusion and is doing well, Dr Mennati said. Today, a British-based world expert said the girls now had a "very good" chance of surviving after coming through the operation at the UCLA Children's Hospital.

Professor Lewis Spitz, from Great Ormond Street hospital, said: "The biggest risk facing the twins now will be haemorrhage. It appears that they share a cerebral sinus, which is a cavity within the skull that drains blood away from the brain.

"You cannot just tie this off - it has to be reconstructed to ensure it works successfully and does not bleed.

"If the brains are separate and the membrane around the brain is intact, the chances of survival with normal neurological functions are good."

He added: "I would expect these girls to survive and develop normally."

The twins were born in Guatemala but were brought to the US in June after a nonprofit group raised the money needed for surgery.

Their parents say the children spent the first year of their lives developing normally in terms of brain function.

But they took the decision to go ahead with the risky operation in a bid to give their daughters the chance of a normal life.

Babies who are joined at the head - known as craniopagus - are the rarest form of Siamese twins, their condition being found in one in a million live births. They are also hardest to separate.

In 1999, there were 30 attempts to separate twins joined at the skull. Only seven of the 60 children survived.

But recent medical advances in both surgery and screening techniques enabled surgeons to attempt separation with more success.

Sophisticated 3D imaging techniques indicated to surgeons the "plane of separation": a theoretical "dotted line" surgeons cut along, weaving through the tissues, blood vessels and veins in order to give both girls the best chance of survival.

Before the operation, the girls also underwent surgery to ensure there would be enough skin to graft over their heads at the end of the separation, minimising the risk of infection.