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Conjoined twins procedure goes 'smoothly'
NEW YORK (CNN) -- Conjoined 18-month-old twins from the Philippines completed the first step on their road to separation Monday. Doctors in New York began the first in a series of operations to separate the Filipino twin boys, who were born joined at the head, by inserting balloons beneath their scalps to expand the skin. The procedure "went absolutely smoothly and completely according to plan," a spokeswoman for Children's Hospital at Montefiore in the Bronx said. Carl and Clarence Aguirre went into surgery shortly after 9 a.m. EDT Monday. Doctors placed the balloons underneath their scalps in a process called tissue expansion. The balloons will be gradually inflated with sterile saline, stretching and expanding the scalp so that enough skin is available to cover their heads after separation. Doctors also performed a craniotomy to figure out how tightly merged the boys' brains are. Neurosurgeons plan to tie off shared veins in an effort to reroute the boys' shared vascular system, which drains blood from their brains. Since March, neurosurgeons and other staff at Children's Hospital at Montefiore have been preparing for the separation -- which is being done through a series of small operations. The boys were born in the southern Philippines and arrived last month in the United States. They have been undergoing nutritional evaluation and rehabilitation. Doctors said the boys suffered from malnutrition. Dr. Joelle Mast of Blythedale Children's Hospital, which has overseen the boys' preparation for surgery, said the twins are doing well. She said they've gained five pounds and had some cavities treated. One also was treated for elevated blood pressure, she said. Mast also said the twins are able to recognize their doctors, nurses and therapists. Dr. James Goodrich -- lead neurosurgeon on the separation operations -- said the boys are in good shape, too. "Both of these kids are in wonderful physical condition right now," said Goodrich, who is director of pediatric neurosurgery at the Children's Hospital at Montefiore. Separation involves multistage procedureThe twins' doctors project a minimum of two or three stages for the separation within the next two months, depending on how well the children respond. "There is enormous risk involved. Everybody is fully aware of that. It is not simple ... but the feeling is we can do it," Goodrich said. "There is a 30 percent risk of neither child surviving, [which is] a better chance than 20 years ago when there was about a 100 percent chance of death for both twins." The team of neurosurgeons opted for a multistage rather than a single-stage procedure, citing a decreased risk of massive bleeding and injury to the brain. "The surgeries themselves will be shorter," said Dr. David Staffenberg, chief of plastic surgery at Children's Hospital at Montefiore. "Blood loss we expect to be less. Exposure to anesthesia will be less. Swelling of the brains would be less and, of course, Carl and Clarence should have every opportunity to do much better." Doctors also said the time between procedures will allow the children to undergo rehabilitation and physical therapy. The twins share their vascular anatomy, the system of veins that drain blood from their brains. The multiple operations will allow surgeons to reroute some of the key veins the twins share. Dr. Steven Safyer said the Aguirres' care is part of a charity effort at the Children's Hospital at Montefiore. He estimates the cost for the entire operation to be around a "couple of million" but said it's difficult to assess at this point. Doctors in Dallas, Texas, separated 2-year-old conjoined Egyptian twins in a 34-hour operation October 12. Doctors said they are pleased so far with the progress of the boys, who also were joined at the head. CNN medical producer A. Chris Gajilan contributed to this report.
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