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Doctors attempt to separate conjoined twins

Wenceslao Quiej smiles as he lifts his conjoined twin daughters Sunday.  

LOS ANGELES, California (CNN) -- A team of more than 50 doctors and nurses at Mattel Children's Hospital at UCLA Medical Center began the intricate, painstaking process Monday of separating 1-year-old twin girls joined since birth at the tops of their heads.

"We are cautiously optimistic in the early goings," said Dr. Michael Karpf, director of UCLA Medical Center. "The parents were there to kiss them, give them good luck kisses, right before they left."

The Guatemalan girls, Maria Teresa and Maria de Jesus Quiej-Alvarez, were wheeled into the operating room at 8 a.m. (11 a.m. ET), but the surgery did not begin until 1:49 p.m., after anesthesiologists put in breathing tubes and intravenous lines to deliver blood and medication, and arterial lines to measure blood pressure.

Using extra skin created over the past month through a skin expansion procedure, UCLA's plastic and reconstructive surgery team then created the skin flaps that were to be used to cover the top of the brain of each child.

On June 24, doctors inserted balloons under the girls' scalp and injected small amounts of saline into them over time, stretching the skin so they will have enough to cover the wounds once they are separated.

By 5 p.m. Monday, neurosurgeons had removed a strip of bone about two-thirds of the circumference of the shared skull to expose the brain and the veins of the twins.

Click here to see a gallery of the conjoined twins 

Illustrations: Separating twin sisters  

They were investigating the vein connection between the brains and attempting to separate the brains.

As of 6 p.m. (9 p.m. ET), surgery was progressing as planned and expected to last at least another 10 hours (until at least 7 a.m. ET), the hospital said.

The team is composed of neurosurgeons, plastic and reconstructive surgeons, anesthesiologists and nursing support staff.

Doctors said that in some respects the girls are lucky: Tests showed they have separate brains normal in size and structure and separated by a membrane, meaning surgeons will not have to cut through any brain tissue. And the arteries that carry blood to their brains are also separate, doctors said.

But the veins that drain blood from their brains are crisscrossed and will have to be rerouted, a procedure that carries the risk of stroke, doctors said.

The girls were born July 25, 2001, after their mother underwent an eight-day labor near their home in rural Guatemala. They weighed 4.4 pounds together. Their mother is a homemaker, their father a farmworker.

An X-ray of the girls' heads shows two distinct, separate brains.
An X-ray of the girls' heads shows two distinct, separate brains.  

A Spokane, Washington-based nonprofit organization called Healing the Children arranged for the girls and their parents to be flown to Los Angeles.

Doctors think conjoined twins result when the usual process in which twins are formed goes awry.

In rare instances, the single egg that would normally divide into two in the case of identical twins does not wholly separate. As a result, some of the body parts are fused, according to experts.

In 40 percent of cases, conjoined twins are stillborn. Another 35 percent of them survive until their first birthday.

In only about 2 percent of cases are the twins joined at the head.

Because such cases are so few, statistics about success rates of surgery to divide them do not exist.

Though the operating room personnel were donating their services, the procedure will still cost about $1.5 million, the hospital said -- beyond the resources of the girls' parents.

The hospital has established a fund to recover expenses.




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