Surgeons enter critical stage in separating conjoined twins

SINGAPORE -- Neurosurgeons performing a dangerous, marathon operation to separate Iranian sisters joined at the head grappled today with rerouting a vein as thick as a finger that helps blood flow through the twins' brains.

An international team of five neurosurgeons probed the brains of 29-year-old Ladan and Laleh Bijani as a crucial phase began in a historic operation expected to last two to four days, said a spokesman for Singapore's Raffles Hospital.

"The next 12 to 24 hours will be a very critical period," Dr. Prem Kumar said. "That might be where we will have to traverse some possible difficulties."

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 Bijani sisters said they would rather face those dangers than continue living joined.

The shared vein is the biggest obstacle in the surgery: Other than sharing the vein, the women's brains are not joined -- though they touch inside their skulls. Their bodies are otherwise distinct.

Dangerous surgery

German doctors told the twins in 1996 that the shared vein, which drains blood from their brains, made surgery too dangerous.

Doctors on Sunday removed a vein from Ladan Bijani's thigh and will use that to compensate for diverting the shared vein to one sister's brain. Doctors have not yet determined which sister will keep the finger-thick vein and which will receive the graft, Kumar said.

Surgeons worked simultaneously 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.

"Everything is going according to schedule," plastic surgeon Dr. Walter Tan said after making the incisions into the twins' skulls.

The twins spent months training at a gym to build up strength for the surgery and Kumar said they could be kept asleep for four days if necessary.

The twins said they wanted to walk into the operating room as a sign of courage, but they were brought in by wheelchair because they were too tired to stand, Kumar said.

The neurosurgeons are used to working 12-hour stretches without pause, Kumar said. Participating neurosurgeon Dr. Benjamin Carson, the director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore, has successfully separated three sets of craniopagus twins -- siblings born joined at the head.

However, this is the first time surgeons have tried to separate adult craniopagus twins. The surgery has only been performed successfully since 1952 on infants, whose brains can more easily adapt and recover.

"If God wants us to live the rest of our lives as two separate, independent individuals, we will," Ladan Bijani said before the operation.

The Bijani sisters were born in Firouzabad in southern Iran in 1974. In a statement read on state-run Iran television late Sunday, President Mohammad Khatami hoped for success.

"The prayers of the Iranian nation are with you," Khatami said in a message addressed to the medical team. "I hope to see my patient daughters Laleh and Ladan healthy and fresh as soon as possible."

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The $288,000 cost of the operation surgery is being underwritten by Raffles Hospital, and the doctors' fees are being waived.

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On the Net:

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

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

Medical Modeling: http://www.medicalmodeling.com/flashsite/itwins.html