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Sanjay Gupta: Risky surgery for adult conjoined twins

Iranian conjoined twins, Ladan, left, and Laleh Bijani will undergo surgery to separate them next month.
Iranian conjoined twins, Ladan, left, and Laleh Bijani will undergo surgery to separate them next month.

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(CNN) -- Two 29-year-old Iranian women joined at the head will have a risky operation in July to separate them, the first time such surgery has been attempted on adults.

CNN medical correspondent Dr. Sanjay Gupta talked with CNN anchors Daryn Kagan and Bill Hemmer about the historic procedure and what the future might hold for Laleh and Ladan Bijani.

GUPTA: You know, there are so few firsts in surgery anymore. But this is certainly one of them. We're talking about conjoined twins, which we've been hearing so much about, because of the Guatemalan twins. But imagine fast-forwarding that process 29 years. And you actually see two women, at 29-years-old, educated women, Iranian women, who have been like that their entire lives.

Everything about them -- the way they comb their hair every morning, the position of their head, the positions of their spines -- all of that has been that way for 29 years. They were born in January, 1974. They've been going through the testing for this, trying to figure out whether or not they can be separated, since November of last year. This (surgery) has never been done before on adult twins.

When we talk about conjoined twins, we often are talking about newborns or very, very young twins. And the resilience of the twins after that operation is much higher. With adults, [there are] obviously a lot more concerns. This is going to be done in Singapore, ... sometime the first week of July.

Probably a hundred doctors and nurses are going to be involved with something like this, everything from neurosurgeons to radiologists to anesthesiologists to plastic surgeons. They're actually flying in a neurosurgeon from Johns Hopkins, Dr. Ben Carson, who has performed these operations around the world before. This is going to be a very big deal in the world of neurosurgery, in part, because it's a very risky procedure, as well.

HEMMER: And what are the risks involved here?

GUPTA: Well, you're doing a significant amount of brain surgery. When you talk about these sorts of procedures, the thing that concerns doctors more than anything else -- the thing that they will literally look at for weeks -- is the blood vessels and actually trying to get a sense of how these blood vessels are connected.

These two twins, Laleh and Ladan, may actually be sharing a significant blood vessel, a blood vessel that drains a lot of the blood from the brain. And a question may arise during the operation, how do you untangle that blood vessel so that they can both still drain a significant amount of blood from the brain?

If you don't do it well, one or both of them might have a stroke afterward or even die, and that's obviously the big concern. ...

Just to give you another sense of the intricacies of this -- one of the girls is connected on the left side of her head, and the other girl connected on the right side of her head. The left side of the brain is much more responsible for speech, for communication, things like that. The right side of the head is more responsible for spatial relations. Do you leave a little bit more (blood vessel) on the twin that has the left side of her head connected? How do you do that? It's all sorts of intricate decisions, a lot of it made in the operating room.

KAGAN: Fascinating. It will be interesting to see how it turns out.

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