Complications mount as surgeons work to separate Iranian twins

SINGAPORE -- Neurosurgeons separating 29-year-old Iranian sisters joined at the head cut through brain tissue millimeter by millimeter Tuesday after rerouting a thick, shared vein and stitching in a new one.

The team of doctors also contended with unstable pressure levels inside the twins' fused skulls as they began uncoupling the sisters' brains, a hospital official said. The risky, marathon procedure -- which could kill both women -- began about 9 p.m. Saturday and could take four days.

The brains of Ladan and Laleh Bijani are separate, but after lying alongside each other for decades are nonetheless stuck together, a Raffles Hospital spokesman said.

The operation could kill one or both of the sisters, but after a lifetime of compromising on everything from when to wake up to what career to pursue, the sisters said they would rather face those dangers than continue living joined.

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The Iranian government said Monday it would pay the nearly $300,000 cost of the operation and care for the twins.

This is the first time surgeons have tried to separate adult craniopagus twins -- siblings born joined at the head. The surgery has been performed successfully since 1952 on infants, whose brains can more easily recover.

Participating neurosurgeon Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore, has separated three sets of craniopagus twins.

Because this operation is a medical first, surgeons have encountered unexpected obstacles not seen in infants. It took longer to cut through portions of their skulls because their older bones were denser than previously believed, Kumar said.

"Every time something like this happens, we have to take stock of what is happening," he said.

As the procedure dragged on, surgeons tried to get adequate rest, slipping out of the operating room for breaks when their expertise was not needed, Kumar said.

Classical music played softly as surgeons worked simultaneously in tight spaces in front of and behind the twins, who are sitting in a custom-built brace connected to an array of lines feeding them intravenously and monitoring their vital signs, Kumar said.

"Nothing is going on at a hurried pace," he said. "Everything is quite calm and measured. There's lots of discussion."

The sisters were born into a poor family of 11 children in Firouzabad, southern Iran, but grew up in Tehran under doctors' care.

As girls they used to cheat on tests by whispering answers to each other, they told reporters last month.

The government caught on and concluded it would be nearly impossible for them to compete individually in university entrance exams, so it granted them a scholarship to study law at Tehran University.

After surgery, the twins hope to move back to Iran and live together while Laleh pursues journalism and Ladan works as a lawyer, said Bahar Niko, 24, a teacher who befriended the sisters in Singapore.

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Editor's Note: Emma Ross, an AP medical writer, contributed to this story from London; AP writer Ali Akbar Dareini contributed from Tehran.

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On the Net:

Raffles Hospital: http://www.raffleshospital.com

Johns Hopkins Medicine: http://www.hopkinsmedicine.org