Surgeons begin operating on conjoined twins

After more than a year of preparation, a team of 18 doctors today began the delicate surgery to separate two-year-old twins from Egypt joined at the crown of their heads.

The surgery, expected to last 18 to 24 hours, is risky – one or both of the boys may die. If they survive, some brain damage is inevitable.

However, Dr. Jim Thomas, director of critical care at the Children’s Medical Centre, Dallas, said ethics boards at two hospitals had reviewed the case and felt it was worth attempting.

“Nobody goes into this lightly,” said Dr. Dale Swift, one of five paediatric neurosurgeons who will operate on the twins. “At this point we think it’s the right thing to do.”

Ahmed and Mohamed Ibrahim were born in June, 2001, by Caesarean section to Sabah Abu el-Wafa and her husband, Ibrahim Mohammed Ibrahim, in the southern Egyptian town of Qus, near Luxor.

Dallas-based World Craniofacial Foundation, a non-profit group that helps children with deformities of the head and face, arranged to bring the boys to Dallas in June 2002 for an evaluation for the separation surgery.

A team of specialists determined that the boys could be separated. Although they share an extensive attachment of blood vessels, each boy has his own brain.

The boys’ father told doctors he felt it was worth the risk, saying he wanted to give them a chance of a normal life.

“If they’re left this way, they’re not going to be normal,” Ibrahim said earlier this year.

There have been at least five surgeries around the globe in the past three years to separate twins joined at the head. Three were successful, one resulted in one twin dying, and in another both twins died.

Dr. Swift said the neurosurgery team reviewed several separation surgeries so they could learn from the successes and mistakes. The Texas team most closely looked at two successful separations of twins joined at the head – Guatemalan twins separated in Los Angeles last year and Nepalese twins separated in 2001 in Singapore.

Using those lessons, Dr. Swift said the team prepared for their surgery, which will include 50 to 60 medical personnel.

“The planning is the most important part of the surgery and takes much, much longer than the surgery itself,” said Dr. Swift, an associate clinical professor of neurosurgery at the University of Texas Southwestern Medical School.