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LIVE FROM THE HEADLINES

Separated Twins Update

Aired May 30, 2003 - 19:31   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DARYN KAGAN, CNN ANCHOR: It has been almost a year since U.S. doctors separated Guatemalan twin girls who were born joined at the head. Now the twins are back at UCLA for evaluation and for more treatment. One of them, in fact, underwent surgery today to replace a shunt that drains excess fluid from her brain. The girl contracted E coli meningitis this spring, infecting the original shunt forcing doctors in Guatemala to remove it.
Our medical correspondent as well as resident neurosurgeon Dr. Sanjay Gupta has performed such shunt operations many times and he's joining us live from CNN Headquarters in Atlanta.

Sanjay, good evening.

SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good evening.

KAGAN: How does this work? How does the shunt operation work? Is it dangerous and how does the actual shunt work once it's in place?

GUPTA: Well, it's a simply a pretty brilliant concept.

Basically, in this girl's case, too much fluid, which is a normal amount -- normal fluid actually built up in her brain. So I think we have pictures to show exactly what happens in this sort of operation.

You can see there there's the skull and that's the skull with the bone there. A little hole is made right there sort of near the front, in this case on the right side. You can see the brain now there and that what you're see going inside there is a little catheter. It's actually made out of sylastic (ph). It's placed, draped underneath the skin and then you can see in the scan there, it actually goes into the normal fluid-filled space in the brain and it's connected to a valve that prevents too much fluid from coming out.

Question is then where does the catheter end up? It actually goes down into the baby's abdomen. You can see the pictures there sort of highlighting that.

But basically, a pretty simple operation, really. One of the most common operations done in pediatric neurosurgery, the goal really to drain the excess fluid, which isn't draining under normal circumstances down into the abdomen.

In Maria Teresa's case, it sounds like what happened the first time around, this shunt was placed and it got infected. Infection is a very common sort of complication of these particular operations. The goal, in this case, really, to remove that shunt and to put a new shunt in and hope that that one does not get infected -- Daryn.

KAGAN: And Sanjay, you yourself have done this operation -- what? -- more times than you can count?

GUPTA: Probably...

(CROSSTALK)

KAGAN: And complication -- does that comes up with it or...

GUPTA: The biggest complication really is infection. That's the thing that people worry about the most.

You're putting a foreign object really into the brain, into the normal fluid in the brain and if that gets infected, it can cause something that you already alluded to, meningitis which is an infection of all the lining of both the brain and the spinal cord. That can be a real problem.

What happens in that particular situation, the shunt comes out. The fluid is drained outside the body for a period of time until that infection clears and then the operation that we are -- that the Maria Teresa had today is performed, which is basically to reinternalize that shunt, back through that same hole, draining that fluid again into the abdominal cavity.

Incidentally, the fluid that goes into the abdominal cavity just gets absorbed over time. It doesn't build up in the abdominal cavity. So it just gets put out of the body under normal -- in the normal way.

KAGAN: And the kind of thing that she'll have the rest of her life, even if she kind of outgrows it, it just stays in there?

GUPTA: Yes, that's a good question. In the case of someone like Maria Teresa ,it probably would stay in the rest of her life.

There's a chance that at some point in her life, over the next few years, she may not actually need the shunt again. But the usual decision making is that unless there's some reason to take it out, such as an infection or some other complication, that it usually stay in -- and i may stay in for her whole life.

KAGAN: And just real quickly, the status of the other twin.

GUPTA: Right. The other Maria. Maria De Jesus appears to be doing fairly well.

She -- as you remember back now in August, Maria Teresa actually had a more tumultuous course right after this conjoined twin separation. Maria De Jesus, you can see the pictures there. She obviously looks like a champ. She has had some wound healing problems in the back of the head where she was separated from her twin sister.

This is not an uncommon thing. Of course, this entire operation is a very uncommon thing, so it's hard to say what is normal and what is not. But she does appear to be doing rather well now, almost a year later.

KAGAN: Well, they also appear to be doing just fine in the cute department. No more treatment for that. They're naturals.

GUPTA: Exactly.

KAGAN: Dr. Sanjay Gupta, thank you for joining us.

GUPTA: Thank you.

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