Separated twin back in operating theatre

One of the Siamese twin girls separated after being joined at the head has been rushed back into the operating theatre after bleeding on the brain.

Less than four hours after the apparently successful operation, Maria Teresa Quiej-Alvarez developed a swelling of clotted blood on the brain that required further surgery.

Despite the setback, doctors said the child's condition was not unexpected. "It needs to be dealt with to make sure the pressure does not build up in the scalp," said Michael Karpf, director of UCLA Medical Centre in Los Angeles.

"This was not necessarily an unexpected complication and the outlook for the twins is still positive."

Surgeons and medical staff burst into tears of joy after separating the oneyearold twins in a 22-hour operation.

Maria Teresa and her sister Maria de Jesus were born in rural Guatemala joined at the top of the skull.

Following the operation, the babies were moved to intensive care where the next two days will prove crucial.

But the surgery team say the intensely complicated surgery went as well as they could have hoped for.

Dr Houman Mennati said that, despite the minor setback, his theatre team was happy. "The mood was more than optimistic - it was overjoyed.

"We can't wait until we see these kids playing, laughing and crying like any normal children."

The only part of the procedure that did not go to plan was that one of the girls started losing too much blood.

But Dr Mennati said: "We were able to jump right on it and give transfusions all the way through and, as far as we can tell, everything is great."

Saline-filled balloons placed under the scalp on 24 June were used to stretch the skin in preparation for the separation. The overall operation included about 50 people, including neurosurgeons, plastic and reconstructive surgeons, anaesthetists, nurses and other support staff.

Neurosurgeons first removed a strip of bone about two-thirds of the circumference of the shared skull before surgeons sorted out veins.

Dr Mennati said: "The room was split into two teams - one for each of the girls, with both teams working in tandem. They first separated the bone between the two babies, actually separating the skulls, then very finely separated the individual blood vessels, making sure that they both had their own circulation in their brain.

"Finally, they separated the remaining bone and skin, rebuilt new bone over the brain of each of the children, and sewed the skull back over that.

"There was no major trouble." The girls, who arrived at the hospital with their mother on 7 June, will stay for at least another week after leaving intensive care. Dr Mennati added: "We have to make sure the brain swelling is diminishing, there are no blood clots, no bleeding on the brain."