Doctors operate to separate twin sisters

LOS ANGELES -- Doctors began operating on 1-year-old twin sisters joined at the head Monday in a long, risky procedure to separate the blood vessels and bone they share.

"We are cautiously optimistic in the early going," said Dr. Michael Karpf, director of the UCLA Medical Center.

The surgery on Maria Teresa and Maria de Jesus Quiej-Alvarez began Monday afternoon, about six hours after they were wheeled into the operating room at Mattel Children's Hospital at the University of California-Los Angeles. It could take up to 24 hours to complete.

"Our goal is to get two twins walking out of here -- maybe not walking, but crawling," said Dr. Henry Kawamoto Jr., a plastic and reconstructive surgeon at UCLA.

By Monday night, neurosurgeons had removed a strip of bone exposing the brain and the veins of both girls, according to a hospital statement. The next -- and riskiest step -- was separating the veins that connect the front of each girl's head to the back of the other.

"Once those areas are exposed, there has to be a disconnection of these two systems. The major issue is how are these two brains going to tolerate that," UCLA neurosurgeon Dr. Itzhak Fried said before the procedure began.

If doctors cannot reroute the flow of blood to the brain of each twin, either could be at risk of stroke, he had said.

No further information was expected to be released until the surgery was completed, UCLA spokeswoman Roxanne Moster said late Monday.

The girls, born in rural Guatemala, are attached at the top of the skull and face opposite directions, a rare case that happens in fewer than one in 1 million live births.