|
 |
INSIGHT
Conjoined Twins Successfully Separated
Aired August 6, 2002 - 17:00:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(BEGIN VIDEO CLIP)
JONATHAN MANN, CNN ANCHOR (voice-over): A small story starts over, twice. An extraordinary operation separates conjoined twins, two girls who may now be able to play, sit and finally see their twin sister's face.
(END VIDEO CLIP)
(on camera): Hello and welcome.
The surgery took 22 hours, but the doctors and nurses in the operating room were crying and celebrating even before they were done. You don't get a sense of the challenge unless you look again at the extraordinary image. Two youngsters attached at the top of the head and facing in different directions.
The girls shared bone and blood vessels and even the same first name, Maria. One or both could have been killed by the effort to separate them. They survived, but it's not over yet.
On our program today, nearly inseparable.
First though, a look at the headlines.
Israeli troops have clashed with Palestinians at a West Bank refugee camp. Army officials say one Israeli soldier was lightly wounded by stones. During the Tuesday evening clashes, the road closure that had been in place in Ramallah was lifted.
Meanwhile, Israeli and Palestinian officials are working out details for a plan to withdraw some Israeli troops from occupied areas. The plan calls for the Palestinian Authority to demonstrate security control in areas around Gaza and Bethlehem.
Also, a Palestinian delegation heads to Washington soon for talks with top United States officials. The United States State Dept. says Sect. of State Colin Powell expects to meet the delegation Thursday or Friday.
Nine Hindu pilgrims are dead and more than two dozen wounded after being attacked by suspected Islamic militants in Kashmir. Police say the attackers were armed with machine guns and grenades as they sneaked into a camp of Hindus making Himalayan pilgrimage. 24 Hindu faithful have been killed in similar attacks since the month long pilgrimage began. Police say the threat of violence is heightened because Kashmiri separatists oppose the Kashmir elections that India is to hold next month.
The European Union has announced a $34 million aid package to Zimbabwe, and it's warned President Robert Mugabe about interfering with its far distribution.
Zimbabwe's opposition and some aid agencies say his government gives preference to members of his Zanu-PF party when handing out aid. The European Union's executive body says the aid will not go through government hands. Instead, it is to be distributed by the United Nations and other aid agencies.
The United Nations says southern Africa is currently facing its worst food crisis in a decade.
In western Mexico, tragedy for a group of pilgrims on their way to Guadalajara. At least 30 people were killed and eight others injured when their bus slammed into a toll booth near Zinapecuaro then flipped over. The town is about 200 kilometers northwest of Mexico City. Authorities say the brakes on the bus apparently failed.
Maria Teresa and Maria de Jesus Quiej-Alvarez were born just over a year ago in Guatemala after their mother spent eight days in labor. She's a homemaker. Her husband works on a farm. And today, they have two very lucky daughters.
We begin our coverage with CNN's Gary Tuchman.
GARY TUCHMAN, CNN CORRESPONDENT: Well, Jonathan, it's been an incredible, momentous and stressful day here at the UCLA Medical Center in Los Angeles.
After 22 hours of surgery, two little girls, just 377 days old, who have been conjoined at their heads all their lives, were separated by a team of surgeons.
A short time ago, we received pictures of the two little girls for the first time in their lives, separated in the recovery room.
They were wheeled into the operating room early yesterday morning. They've been conjoined at the top of their head. These two little girls have never even seen each others faces because of the way they were joined together.
Surgeons worked through the day and the night last night, and then shortly before dawn this morning we were told the surgery to separate them went successfully.
However, there has been a small complication. The two little girls, named Maria Teresa and Maria de Jesus, they are from Guatemala, Maria Teresa, who is the larger one of the two girls, had the little complication. Doctors say it's manageable, but nevertheless it's disappointing.
(BEGIN VIDEOTAPE)
DR. MICHAEL KARFP, UCLA MEDICAL CTR.: At 9:17, Maria Teresa was taken back to the operating room to deal with a subdural hematoma. A subdural hematoma is a collection of blood underneath the scalp and it needs to be dealt with to make sure that the pressure doesn't build up in the scalp.
This was not a necessarily unexpected complication. Dr. Jorge Lazareff has sent word that he thinks that this will be manageable and that he still feels that surgery can be quite successful for Maria Teresa.
(END VIDEO CLIP)
TUCHMAN: So after that 22 hours of surgery, this surgery for Maria Teresa has now been going on for about four hours. We expect to hear an update from hospital officials on her progress. We are not being told so far how she is doing, but once again, it was stressed to us, after it was announced the separation was successful, that there could be complications, that the hours, days and weeks afterwards were very crucial, so they tell us we should not be surprised or necessarily disappointed by this.
But, either way, the separation, and a very complicated procedure it was, was successful -- Jonathan.
MANN: It's hard to imagine where something like this would begin, how it would be managed medically. Tell us about the medical operation -- how many people involved, what the atmosphere was like as the hours dragged into nearly one full day, nearly a complete 24 hour cycle of surgery in that operating room.
TUCHMAN: Well, exhaustion would be putting it lightly, Jonathan. They were very tired, we are told, and you wonder now how they're doing, because the same doctors are in there performing this next surgery right now. We should find out more about that later.
But we were told that during the surgery, at the moment where they actually separated the twins from each other, there was high-fiving, there was clapping, there were tears in people's eyes.
They knew of the possibility of complications down the road, but this was a very crucial step, getting them separated and having them stay alive, frankly, while it happened. And they were very happy and exhilarated when it happened.
Now they're all in there, hoping for the best for little Maria Teresa. Her sister, by the way, is in critical but stable condition, and she is in the recovery room right now, as are her parents, who have been here for two months with their daughters as they prepped for the surgery, and they're all together inside this building behind me.
MANN: This whole thing is so hard to imagine. What was life like in their home for those children. What's it like trying to raise two babies joined that way?
TUCHMAN: Well, these children never did come home to their small home in the rural part of southwestern Guatemala. What happened was, they were sent to the -- one of the finest hospitals in Guatemala that had a neonatal unit. It was six hours away from the parent's home. They took a bus to visit their daughters every few days. They would then go back.
They apparently could not afford to stay at any lodgings or did not know anyone to stay near the hospital, so they traveled back and forth for months to visit their daughters. Then they found out the wonderful news, that the surgery would be performed free, the doctors are not taking any pay for this, a charity has paid for their travel. The hospital itself says this will cost $1.5 million. It will take donations, but it will subsidize the rest of it.
So this is really a dream come true for these parents and certainly it was a wonderful moment this morning when they were told that their daughters were separated successfully.
MANN: I hate to dwell on this, but just the logistics of trying to care for children who can't sit up properly, who can't really crawl, who I would imagine couldn't really be fed in the same way at the same time.
TUCHMAN: It's really incredible, Jonathan.
The children did not take solids until just a few weeks ago. They just turned one on July 25th. Children start taking solids usually before that. And what happened was, when they started giving the children their solid foods, they had to position one of the girls on her side so the other girl was upright to eat her food.
As far as bathtubs go, another example, here at the hospital. They would literally hold one of the girls upside down while the other girl went right side up in the bathtub, and then they'd reverse the process.
And what they told us about was Maria Teresa, the one who is in the operating room right now, the bigger one of the two girls, and what they would do -- the two girls would be lying on the table and they'd be fighting to turn over and they'd be fighting to go in opposite directions, and it was usually Maria Teresa, the bigger girl, who would win those battles.
Now, providing everything goes well, and we are certainly all fans here -- we're not just journalists right now. We're television viewers. We're all fans of these two girls. Certainly, if everything goes well, they'll be able to do a lot of things on their own now.
The fact is, if they were not -- if the surgery did not occur, they could have lived indefinitely, but the quality of life, obviously, would have been very poor.
The fact is, these are now two girls who will have a very good chance at completely normal lives. They had their own brain functions. Their hearts were the same size, which indicated that one heart wasn't doing the work for the other child. It was just veins that were interconnected. That was the complicated part of this.
They got the girls apart, and they can live very normal lives, providing they can make it through the days, weeks and months to come, the crucial time.
MANN: And they probably won't remember a thing.
Gary Tuchman, in Los Angeles, thanks very much.
We have to take a break. When we come back, the science and the surgery.
Stay with us.
(COMMERCIAL BREAK)
(BEGIN VIDEO CLIP)
MANN (voice-over): It doesn't happen often. The odds of being born attached to another person are 200,000 to 1. The odds against being joined at the skull are even more remote, but twins who are attached that way don't beat the odds for long.
Few live even to be just five, and only one set is known to have ever reached adulthood.
(END VIDEO CLIP)
(on camera): Welcome back.
By that standard, the two Maria's are lucky. The two girls shared so much, but had complete and separate brains. And technology and surgical techniques are better now than ever before.
A short time ago, we spoke to medical correspondent and neurosurgeon Dr. Sanjay Gupta.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: You know, this is one of the most complicated, sophisticated, intricate operations in neurosurgery, probably, and that's really saying a lot, because there's a lot of intricate operations in neurosurgery.
Only about 5 or so of these have been done over the last 10 years. The surgeons at this hospital had never done this operation before, an important point.
But, absolutely, these girls have beat a lot of odds. 40 to 60 percent of them are born stillborn, that is conjoined twins. 35 percent don't survive beyond a year. So, these girls celebrated their birthday just last month and have now undergone this rather historic operation. Certainly, historic for them and for UCLA.
MANN: Tell us about what the doctors were working with and how they did it.
GUPTA: You know, there was a lot of planning for an operation like this, and that's an important point, because the planning of an operation like this is different than the planning was even 10 years ago.
Example: they actually take these images of the two brains together and they actually create these three-dimensional models. They take images like the one you see there and create three-dimensional models with not only the brain, but also the blood vessels.
Why? So they can actually map these things out and get a pretty good sense of exactly what they're going to do on this model before they actually do it in real life. And as you can see on this image here, Jonathan, the -- if you look at the sort of middle line there going from top right to bottom left, you get a sense of this membrane between the two brains.
You already mentioned, the two brains weren't actually interwoven, interconnected. This membrane separated those two. But that's also the place where a large vein runs in the brain normally, and in this particular case -- I'll show you this model over here.
This vein, instead of draining along the top of the brain and then going to the back of the brain, like it normally should, it actually drained into the back of the brain of the twin.
So, Maria #1's big vein here drained into the back of the brain of Maria #2, and the same thing. Maria #2's big vein over here drained into the back of Maria #1. And that is what everyone has been talking about, in terms of the intricacy of this operation, actually manipulating those veins, actually trying to make sure the veins could still drain properly. That was the most challenging part of the case.
MANN: In the preparation, how hard was it to figure out which blood vessels, which veins, belong to which of the twins?
GUPTA: That's an extremely challenging thing, and I don't know if there's any better way to describe it than literally looking at, you know, bunches of strands, almost like spaghetti-like strands together, and trying to trace them back. The only problem is, you can't really pick these strands out and look at them, like you would a noodle in a bowl of spaghetti. You really need to be very careful with these blood vessels. You cannot tear them. They're very thin.
So you have to literally go back and forth and try to be sure, 100 percent sure, that the vein goes to one brain or the other. That's also where these models came in handy. They were able to actually look at these models, and get a pretty good sense, looking over and over again, and then when they got inside the operation, comparing the model again, to be sure which vein was which.
MANN: What kind of risks did the girls face -- do they still face now?
GUPTA: Well, they still do face now.
The risks, you know, before the operation, certainly during the operation -- stroke is the biggest risk that people talk about, and that is from actually manipulating these blood vessels, having what is called a venous stroke. That's when the blood actually is building up in the brain, and that can cause stroke-like symptoms.
Bleeding is another complication that they're very mindful of, and certainly we've already heard about some bleeding in one of the twins. Bleeding that collects on top of the brain is not unexpected, not uncommon, although obviously not desirable as well.
Clots can form in the blood vessels themselves, and that can cause all sorts of problems. And certainly, Jonathan, just damage to the brain. You're manipulating the brain quite a bit, separating those two.
I will say that a one-year child is very resilient to things like that, thankfully, so that they should do pretty well from a brain standpoint.
MANN: What happens now? The girls are separated, but do they have the brain, do they have the bone, do they have the skin that they're going to need to lead regular lives?
GUPTA: Well, they do have the brain, and the bone, you know, again, in a one-year-old, the bone around the skull will continue to mottle, or form, if you will, so they can mottle for up to another 14, 18 months or so. So they will probably develop a lot of bone.
As far as this particular operation, they probably used some of the girls own bone to cover up the defect, or the hole, if you will, where the operation was performed.
And, if you remember, Jonathan, as well, they actually put these tissue expanders, these skin expanders, underneath the skin a month ago. Why? To basically allow the skin to expand so there'd be extra skin there to cover up this defect from the operation.
The brain, you know, the brain itself, like I said, there's obviously manipulation of the brain from this operation, but with a one-year-old, I think the function of the brain should be pretty normal, even within a few days.
MANN: Every time we hear about medical efforts to separate conjoined twins, especially twins who are joined together in such an intimate way, there is always, it seems, a risk to one of them or to another one of them. Often, it's a terrible choice for the parents who have to confront the fact that they might lose one of their children.
Did both of these girls have an even chance of getting through this surgery? Or was there a smaller, weaker partner that was more at risk?
GUPTA: You know, that's an excellent question, and statistically, you're right on the money.
25 percent of the time only do both twins survive, and that's sort of a disarming number, especially when you think about it in the context of these two Maria's.
But that decision-making is often done in the operating room. And it is probably one of the most devastating sort of possible outcomes, where you have to make a decision that you're sure will invariably leave one alive and one not, and that's something that's done usually looking at those blood vessels, and trying to determine if, you know, taking a blood vessel will obviously be a very good thing for one of the twins and a very bad thing for the other.
In this case, it doesn't sound like that happened. But you're absolutely right, Jonathan. That is a decision, the intraoperative decision, that surgeons are sometimes confronted with. Not an easy one. A lot of times, surgeons will actually scrub out of the operating room and go sit down and have a heart-to-heart talk with the parents. And, not an easy discussion by any means, but sometimes that's what needs to take place.
MANN: An extraordinary story. A lot of people praying, have got their fingers crossed, waiting for more good news from these girls.
GUPTA: That's right.
MANN: Sanjay Gupta, thanks very much for talking to us.
GUPTA: Thank you, Jonathan.
(END VIDEOTAPE)
MANN: Another break, and then a conversation about our strange fascination with people paired at birth.
Stay with us.
(COMMERCIAL BREAK)
MANN: Welcome back.
Conjoined twins have been documented throughout history with a mix of myth and misunderstanding.
One of the earliest cases was that of the Biddenden Maids who lived in southern England in the 12th century. Mary and Eliza Chulkhurst, who were joined at the hip and upper body, were from a well-to-do family and lived in relative peace.
When one of the sisters died at the age of 34, the other faced a dilemma. Doctors wanted to save her by cutting her free, but she refused.
"As we came together, we will go together," she said. She died a few hours later.
Gretchen Worden is director of the Mutter Museum of the College of Physicians at Philadelphia, which has a conjoined twin exhibit called Body Doubles, and he (sic) joins us now.
Thanks so much for being with us.
Let me ask you first of all about us paying so much attention to these two girls. This is a media age, and these two young girls, the two Maria's, are suddenly celebrities. Is that somehow different than it used to be? Or have we always been fascinated by these people?
GRETCHEN WORDEN, MUTTER MUSEUM: No. We've always been fascinated by these people. I mean, we're interested in anybody that looks different from us, and conjoined twins are more different than almost any other abnormality.
MANN: Do you have any idea why we're so fascinated by strange-looking people?
WORDEN: I think it's just human nature. Maybe it's the idea of identifying the other, so that you know who's safe and who you should be scared of. I don't know, but it is -- it's a human phenomenon.
MANN: And you point to something very intriguing, which is when people are different, when they're frightening, we're afraid of them. And yet these days, at least, we think of conjoined twins as victims, as people who deserve special compassion and extraordinary medical efforts. Has that always been in human nature?
WORDEN: No, it's -- they have been regarded as something special, but not necessarily as victims. And even today, there are conjoined twins that are living extremely fulfilling lives.
MANN: Tell me more about that. How many conjoined twins are there are there who are adults? We talked about the fact that not many survive when they're joined at the head, but presumably others have better luck.
WORDEN: I know of two sets, right now. Oh, no, actually there are more. I don't know exactly how many, but I can think right off the bat about three or more.
MANN: And how have they adapted to being joined?
WORDEN: Some have adapted very well. I think the closest example to the twins that were just separated is Lori and Reba and Schappell, who live near Philadelphia, and I just talked to them yesterday and they are about 40 years old, and Reba has a career as a country western singer, and they're doing very well.
MANN: It's hard to imagine, and I'll apologize to our audience, we don't have any pictures of these two ladies. One of them is a country and western singer. What does the other one do?
WORDEN: She just is very supportive.
MANN: I would imagine so. I would imagine so.
What kind of emotional lives do adult conjoined twins have? How hard is it, psychologically? And how had is it socially for such different people?
WORDEN: Well, you have to remember, they've never known any other condition, so for them it's not strange. They begin adapting to the situation from the time they're born. And so, for them it's normal and they learn how to live together.
And it's interesting, the literature about conjoined twins, you hear about the fact they're always very different personalities, and they learn to compromise. Something just as simple as making a decision about when to go to the bathroom. And they just learn this and do it intuitively from the time they're born.
MANN: Some of them actually marry. Is there much literature, much known about how that works out?
WORDEN: There is some. Probably the most successful marriage was that of Chang and Eng Bunker, the original Siamese twins. And they married at the age of 43, and they -- actually, no, I think it was earlier. And they married sisters and they raised a total of 21 children.
MANN: Now all of this talk is about conjoined twins who have remained together. The two Maria's have been separated. When did people start trying to separate or successfully separating conjoined twins?
WORDEN: The first separation I could find was in 1495. They were twins joined at the head. They were 10-year-old girls. One died and they cut off the dead twin, and the other, unfortunately, died shortly after.
The first successful operation I could find on craniopagus twins, which is what we're talking about, joined at the head, was 1952, where both twins survived.
MANN: And how has the success rate been since then? Do they tend to survive now?
WORDEN: The success rates of all conjoined twin separations are going up. The mortality rates, I believe, are higher for craniopagus twins and for some of the other kinds. For twins that are joined at the heart, I don't believe they have yet done a successful separation in which both twins have survived.
But no, the kind of teamwork you can put together today in a modern hospital, and the kind of imaging you can do to prepare yourself beforehand -- they -- you still get surprises, oftentimes, when you actually go in. The success rate is definitely increasing every year.
MANN: In English, and I suppose in other languages that have been influenced by English, conjoined twins is a more polite phrase than Siamese twins, which is what most people call them in private. Why is conjoined twins -- why are they called Siamese?
WORDEN: They're called Siamese twins after Chang and Eng Bunker. They were the original Siamese twins, because they came from Thailand in 1829 to America. They were actually -- they're known as the Chinese twins in Thailand, because they were 3/4 Chinese.
But in their time, they were born in 1811 and died in 1874, they became the most famous Siamese, the most famous conjoined twins, in the world, and it's because of their fame that they gave that name, Siamese twins, to all -- the whole field of conjoined twins.
MANN: Are conjoined twins themselves offended by the name? Are the people of Siam offended?
WORDEN: Oh, no. As a matter of fact, they've just erected a statue to them over there. They're very proud of them. They were remarkable individuals.
MANN: Was there any thought to separating them?
WORDEN: Oh, yes. The -- that question started coming up as soon as they arrived in this country in 1829, and one of the things they would do, is every time they would go to a town or a city for an exhibition, they would consult with the doctors of that town and pose that question, could we be safely separated.
It was a wonderful gimmick to get publicity. And the answer was always no, it would be too risky.
And so when we did the autopsy on those Siamese twins, in the Mutter Museum of the College of Physicians in Philadelphia in 1874, that was the big question they were trying to answer: could they have been safely separated. And the conclusion was, no, it would have been too risky.
MANN: An intriguing, intriguing bit of history. It's still making news today.
Gretchen Worden, of the Mutter Museum of the College of Physicians at Philadelphia, thanks so much for talking to us.
WORDEN: My pleasure.
MANN: One last thing, before we go, as rare as conjoined twins are, there is another set in the United States right now also joined at the skull.
The two boys, born in Egypt, have been undergoing tests to see if they are good candidates for separation surgery. Doctors are still trying to decide, but the success so far in Los Angeles may bode well for young Ahmed and Mohammad. We'll try to keep you posted.
That's INSIGHT for this day. I'm Jonathan Mann. The news continues.
END
TO ORDER VIDEOTAPES AND TRANSCRIPTS OF CNN INTERNATIONAL PROGRAMMING, PLEASE CALL 800-CNN-NEWS OR USE THE SECURE ONLINE ORDER FROM LOCATED AT www.fdch.com
|
|
|
|
|
