Oct. 16, 2003, New York City, NY -- At a news conference held today at The Children’s Hospital at Montefiore (CHAM), the surgeons who will lead the teams in separating the Filipino conjoined twins said the two infant boys were both in “wonderful condition right now.”  They described in detail, using 3-D models, how and why they were planning to perform a series of operations, beginning Monday, Oct. 20, 2003.

Present were:  Steven M. Safyer, MD, Chief Medical Officer, Montefiore Medical Center; James T. Goodrich, MD, Director, Division of Pediatric Neurosurgery at CHAM and the team leader; David A. Staffenberg, MD, chief of Plastic Surgery, CHAM; and, Joelle Mast, MD, Chief Medical Officer of Blythedale Children’s Hospital.

Pre-operative Health Status

The team reported on the pre-operative health status of the 18-month-old twins, Carl and Clarence Aguirre, conjoined at the head, who have been undergoing nutritional, physical and occupational therapy for over a month at Blythedale Children’s Hospital in Valhalla, New York.

• Carl and Clarence have gained five pounds (in total) since arriving in the United States on September 10.
• Clarence, the smaller of the two boys, is being successfully treated by doctors at CHAM for hypertension.
• Their dental decay was treated at CHAM, reducing chances of post-surgical infection.
• Both Carl and Clarence are expressing an “eagerness to be on their feet” judged by their willingness to push their feet up against caregivers hands.
• On an emotional and developmental level, physicians can “see in the boys' eyes” that they are aware of their condition compared to other children their age at Blythedale who are playing on the floor, and getting up and exploring their surroundings.   Because of their condition, Carl and Clarence have never been able to sit up or stand.
• Through physical and occupational therapy, the twins’ muscles are stronger and their eye-hand motor reflexes have improved.
• The boys have very different personalities: Carl, the larger twin, is more of the “philosopher” while his brother, Clarence, is more active and flips his larger brother over at will.

 

Several Stages to Complex Operation

Using computer generated photos, animated 3-D images and translucent models of the twins’ heads showing relevant major blood vessels, Montefiore physicians described in detail why they are planning the surgery in stages and what the first operation will entail. 

• On Monday, October 20, Dr. David Staffenberg, the craniofacial plastic surgeon, and his team will implant balloon-like devices called “tissue expanders” which will be gradually filled with sterile saline in order to expand them and thereby stretch the boys’ scalps.  This will provide additional skin needed for reconstruction after their separation.   Dr. James Goodrich, overall team leader and neurosurgeon, will work with his team to perform a craniotomy, “making a small window in the cranium so we can explore how tightly adherent the neural tissue is,” said Dr. Goodrich.  The surgeons may also tie-off and divide some of the shared veins.  
• “The operation itself is expected to last 3-4 hours.  After a few days of observation at Montefiore, the boys will return to Blythedale Children’s Hospital for continued physical rehabilitation,” said Dr. Staffenberg.
• Dr. Goodrich said, “at least three additional procedures are planned, probably several weeks or even months apart, before the final separation surgery.”  In all, the series of operations will take place over no less than a two-to-three month period.  During these procedures, surgeons “will close off the bridging veins from Carl to Clarence and vice versa, which will encourage them each to further develop their own venous networks.”    
• “After this vein rerouting is completed, we will then separate the twins,” said Dr. Goodrich.  “We will use existing skull bone to close up the twins’ separate skulls and use the extra “expanded” skin to complete the plastic surgery,” said Dr. Staffenberg. 

Drs. Goodrich and Staffenberg said they have reviewed 84 of the 90 cases of surgical separations of twins performed in the world to date.  “We decided that a series of shorter procedures was preferable to one lengthy operation,“ said Dr. Goodrich. “We believe this will reduce the risks from bleeding, require less anesthesia, reduce swelling of the brain, and allow for continued rehabilitation.”   Precedence for conducting separation surgery in stages includes three operations at Salt Lake City, Utah.

© 2012 Montefiore Medical Center