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New York City, NY (February 21, 2004) – At a news conference this morning, doctors at The Children’s Hospital at Montefiore (CHAM) said they were “quite pleased” with the results of the third in a series of surgeries designed ultimately to separate 22-month-old conjoined twins, Clarence and Carl Aguirre. The 5-hour surgery, which took place Friday at CHAM, focused on tying off one of two remaining major veins and a series of smaller veins that the twins shared at the back of their heads.
“We have completed the major part of the operation,” said James T. Goodrich, MD, director of pediatric neurosurgery, CHAM. “However, even though we have worked around almost 90 percent of the skull to date, with only 2-3 inches remaining, the road ahead remains extremely risky.”
“We have one more major vein to assign in the next operation,” said Dr. Goodrich. “I would characterize the series of operations we have performed to date as tedious, treacherous and tenacious.” Goodrich would not speculate about how many additional surgeries it might take to completely separate the twins.
“Their spirits have really bounced back overnight,” said David Staffenberg, MD, chief of plastic surgery at CHAM. “Clarence gave me his customary ‘hi-five’ greeting this morning, and Carl showed off his ‘wiggle dance’,” said Staffenberg.
“While the boys’ moods were spirited, medically speaking the twins need to be monitored carefully for at least 72 hours,” said Dr. Goodrich. “They are still at risk for post-operative bleeding, seizures and other complications.”
The boys’ mother, Arlene, stayed up all night with the boys in their room, and said she was very pleased with the results of the surgery. She is especially happy to see her boys “acting like their old selves,” she said.
According to doctors, the most difficult part of the third surgery involved elevating the bone flap in the boys’ skulls to create a window through which the highly complex surgery on the tangled veins could be performed.
“The abnormal network of veins the twins share was actually imbedded in the bone flap and needed to be cautiously removed, which took us over an hour,” said Dr. Goodrich. “Without extra care and a millimeter-by-millimeter approach, the children could have bled to death within five to six minutes,” said Dr. Goodrich.
Doctors at CHAM designed the separation procedure as a series of shorter operations to enable each of the brothers to gradually develop their own independent venous systems so they can survive once they are separated. During Friday’s procedure, an entire shared network of veins that have formed a “lake” of blood between the brothers was given to Clarence.
“Carl, the larger of the boys, originally owned only twenty percent of the shared venous system, and now has begun a remarkable process in which his existing veins have matured and become larger,” said Dr. Goodrich.
“After the two previous surgeries, in which several of the boys’ shared veins were tied off, we have watched the circulatory system in Carl’s brain compensate with a ten –to-fifteen percent increase in deep venous circulation,” said Dr. Goodrich. Developing independent venous systems is necessary for both twins to survive.
“We are right on plan,” said Dr. Staffenberg. “However, I’ll be holding my breath until Carl and Clarence graduate from medical school.”
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