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“You Now Have Two Boys,” Surgeon Tells Mother
New York, NY, (August 5, 2004) -- At a packed news conference on Wednesday, August 5, 2004 surgeons at The Children’s Hospital at Montefiore (CHAM) described how they overcame a potentially troublesome last-minute surgical problem and talked about the emotional jubilation of the 16-member surgical team who burst into applause when the Filipino twins, Carl and Clarence Aguirre, were finally separated at 10:32 p.m. on Tuesday night, August 4.
The 17-hour operation was the fourth and final in a series of staged procedures to separate the conjoined twins over the past 10 months. This is the first operation in New York to separate conjoined twins and, the surgeons hope, the first in medical history to enable both two-year olds to develop into healthy, happy and normal children and adults. If that is accomplished, it would be a medical and surgical first, as no other surgically separated conjoined twins have survived surgery without neurological damage.
Midway through the operation, while slowly teasing apart the two tightly abutting brains, surgeons discovered that a small two-inch by two-inch portion of the twins’ brain tissue was actually fused. After 1 ½ hours of planning and discussion, the exact location of the fused site was determined using MRI images that were interpreted by Allan L. Brook, MD, director of Interventional Neuroradiology at Montefiore. Then, James Goodrich, MD, director of Pediatric Neurosurgery, selected the most “embryologically appropriate” site midway along the fused brain tissue to finally divide the twins. He and neurosurgeon Willy Lopez, MD, then reconstructed the dura mater, the sac of tissue that lines the brain, for each boy individually, using an artificial tissue.
When the brain separation occurred at 10:32 p.m., the surgical team burst into applause and David A. Staffenberg, MD, chief of plastic surgery at CHAM, left the operating room to wake the boys’ mother, Arlene, held her hands and told her that “you are now the mother of two sons.”
As of 2 p.m. on Thursday, the twins were in separate beds in the same intensive care unit room and were sedated for comfort. They are both “solid, steady and stable,” according to surgeons. The boys both now lack a large part of their skulls where they had been joined, and these portions of their skulls will be reconstructed over several operations in the ensuing months.
Dr. Goodrich said that the next few weeks are critical in determining if the separation surgery would be a long-term success. He said they still have a “big concern” about Carl, the larger of the two twins, developing hydrocephalous, or severe dilation of the brain’s blood vessels. He also said that because the boys’ brains had been fused in a tiny area and may have been “talking to each other” he did not know the “long term implications of this.” “Where the boys will be in five years, I just don’t know,” he cautioned. "It was kind of scary” when the applause erupted in the operating room," he said. He also praised the “marvelous surgical team” who were in the OR until 3:30 a.m. and were back at the operating room helping others at 8 a.m. on Thursday.
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