CNN LIVE EVENT/SPECIAL
Team Of Neurosurgeans Rejoice After Successful Separation Surgery In Dallas
Aired October 12, 2003 - 17:45 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. JAMES A. THOMAS, CHILDREN'S MEDICAL CENTER: ...my pleasure to introduce on of the boy's neurosurgeons, Dr. Ken Shapiro, who will introduce other members of the team to you. After that, we'll have a brief period for your questions, at which time I'd ask you to raise your hand and wait to be acknowledged and have the microphone approach you and then go ahead and ask. Dr. Shapiro
DR. KEN SHAPIRO, CHILDREN'S MEDICAL CENTER: Jim, thank you, so much. The team members that are sitting here with us are just a few of the many people who have contributed to the care of these kids.
A year ago, over a year ago, Ken Salyer who seated to my, two over to my right asked us as neurosurgeons for children to review studies on the conjoined twins. And we agreed to get involved in their care, if it seemed medically and ethically appropriate.
Because of that commitment, we've assembled a team that included neuroradioiologist, including Chris Sorre who is not here, Nancy Rollins, who has been here and been incredibly helpful to us, and then we started to get involved with people like Maria Ortega, whose to my right, whose an anesthesiologist whose been involved in many separations of conjoined twins.
We had to enlist the support of the administration of two hospitals and especially John Dragovitz here at Children's, and John, of course, got us involved with Karen Norton, who has been beeming right now, but I don't think has been feeling that way all the past weeks, and Wendy Yader, who has been our ace neurosurgical nurse and unfortunately, has been promoted to higher things, but has done phenomenal things for us.
Our team consists of a group of neurosurgeons called Neuroneurosurgeons For Children. And I'd like to introduce each of them to you.
Dale Swift, who is to my immediate left, has been responsible for staying up every night for the past year trying to map out the anatomy of these kids and devising the surgical plans. Dale's a first rate neurosurgeon has been a leader in the separation and the surgical events that occurred today.
Fred Scarr who has been together with me for more than a few years, also worked with Dale in establishing the surgical plan, and again, bears a lot of responsibility for the surgery that's been conducted today. Brad Wheprin, who, again, is a first rate surgeon, and was also up all night with us, is responsible for taking care of the kids afterward, and we expect that he's going to give us the same smooth sailing that he gave us during the operation today.
And David Sacko, who has been working with our practice, helped out a lot during today and during some critical events, really provided the input we needed to make everything work.
Kristine Carmen, who is one of Ken Salyer's associates has been invaluable in helping us, not only in the planning, but also looking after the kids in terms of their the reconstructive parts of their surgery.
We have had the most incredible support I've ever experienced in my years as a pediatric neurosurgeon, not only from a community and a hospital or hospitals, but also industry. And I'd like to publicly acknowledge the help that the guys from KCI, John Vralasic. Perhaps can you stand up. I'm sure all of you have seen...
SHAPIRO: I'm sure all of have you seen the special bed that these guys who usually are involved in making beds for bariatric patients have devised for these two kids. And we've had numerous meetings. The company's been incredibly committed to the design of a table that has very limited use in the real world, and I can tell you today that, without that, we wouldn't be having this conference today. We'd still be working, maybe about three days from now we could have the conference.
Andy Christianson. Is Andy here?
UNIDENTIFIED MALE: Yes.
SHAPIRO: Where? Andy, stand up.
SHAPIRO: Andy's made models of the kids from day one, and every time we've been confused about where we're going in the surgical planning, Andy's come up with a new model that's enabled us to understand what we're doing and to create a surgical road map, and even created a special model that enabled us to test the special bed that John and his colleagues made for us.
And lastly, I'd like to acknowledge Chuck Dinkler from Sherer Mayfield. Chuck, could you stand up?
SHAPIRO: We were kind of casually talking with Chuck's company about making a special headholder for kids and off the cuff we asked Chuck if he could do something special for kids who were joined together at the head, and he took it upon himself as a special project to come up with it. And he, again, has created an incredible surgical structure that's made it possible for us to do the surgery today.
So I'd like to acknowledge all the people and not only in the medical community, but also in the surgical community who have helped us out, and open up questions to you.
QUESTION: Simple question, how are the boys doing?
SHAPIRO: The boys right now are medically stable. We are still completing the skin closure on them. Our plans basically are to keep them in a medically-induced coma for several days. So at this point, we can say that their vital signs are stable and we don't see any sign that there have been any medical problems.
QUESTOIN: At what point in the surgery did you encounter your most difficult problem, and like about what time of night was it and what was it?
THOMAS: Dale you want to speak to that?
DALE SWIFT, CHILDREN'S MEDICAL CENTER: I think the most difficult part was actually separating Mohammad's left hemisphere from the interface with Ahmed's right hemisphere. That was a bit of a surprise for us, for me, perhaps. I think Brad predicted it, but I hadn't conceived that it was going to be that difficult. It was very, very stuck together. And we had, it accounted for, I think the most difficult part of the operation.
QUESTION: Were there neurological...
SWIFT: It really didn't have anything no do with vessels. We knew that the brains would be sticking, touching each other, but we thought most occasions they'd peel apart relatively easily. But hIn this location they did not.
QUESTION: What kind of neurological deficits do you anticipate the boys will have, or is it too early?
SWIFT: I think it's too early to tell.
QUESTION: What material, either natural or synthetic, did you use to replace the duramater with and the skull bones with to close the boys' heads?
THOMAS: Ken, maybe you'd like to answer that?
KEN SALYER, SURGEON: Sure. I'd just like to say, it's been an honor and pleasure for me to be with this great team, and they all deserve a major applause, and my plastic surgery team, the rest of them are in the operating room finishing, so they couldn't be here, my partner, Dr. Jenico.
To answer that, we like to use, and we all agreed upon on our long journey of planning this surgery to try and use the patient's own tissue. So we generated putting tissue expanders in each thigh of both boys. The material that we would use to cover, that the material that the neurosurgeons would use to cover the brain, the duramater. And that's what we used. Mohammad required three of the four, and Ahmed, the fourth one.
We don't try to recreate the skull at this time, but we reserve that for surgery to be performed later on. So there's no attempt to replace the cranium that's gone. As far as the skull bone itself.
QUESTION: Last summer, you mentioned to me you thought this was pretty much insurmountable, and yet something obviously changed. So what's changed between then and now?
SALYER: I think very careful planning and step by step analysis of the possibilities, working very closely with all the team members, but particularly the neurosurgeons, I think the neurosurgeons deserve a special hand and recognition for their persistence in developing a plan that would eventually work. And we, at least I didn't know for sure whether any of this is going to work, and certainly, we worked to try and minimize the possibilities for complications and problems, and I think we eventually agreed on a plan that we thought would work.
SHAPIRO: I think one of the issues we as neurosurgeons have, is that in looking at the brains of these boyce, it's very difficult to conceptionulely understand how the blood comes and goes from the brains.
I think after a lot of time with models and dale went out to los angeles, after the Guatemalan twins had been separated and spent a lot of time there, I think we learned a fair amount about what is possible, and how to interpret the studies we had. And I think armed with that, and plus I think some very detailed planning, we felt more comfortable proceeding.
QUESTION: Much had been said about how many vessels you would have to deal with, and the way that the sinus was set up. How much did you eventually have to clip, if you will, work with, and since there was so much discussed before the operation, how did you overcome all that?
SHAPIRO: We clipped just enough to separate them.
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