Aug 7, 2002 2 min read

LOS ANGELES (AP) – One-year-old Guatemalan twins joined at the head were separated in a marathon operation that ended early Tuesday, but one sister was returned to surgery less than four hours later because of bleeding on the brain. Maria Teresa Quiej-Alvarez was wheeled back into the operating room at midmorning and remained there into the afternoon, longer than expected.

The surgery-related hematoma, or bleeding on the brain, “was not necessarily an unexpected situation,” said Dr. Michael Karpf, medical director at the University of California at Los Angeles Medical Center.

Her sister, Maria de Jesus, remained in critical but stable condition.

“This is very complicated surgery, and until we get past several days it will be life-threatening for both of them. We are minute-to-minute, hour-to-hour, day-by-day. We just can’t get ahead of ourselves,” Karpf said.

The girls’ parents, Wenceslao Quiej Lopez and Alba Leticia Alvarez, kissed their girls before the risky separation surgery, which took 22 hours to complete. At least 50 people participated.

The girls were born attached at the top of the skull and faced opposite directions. While the two shared bone and blood vessels, they had separate brains. Cases like theirs occur in fewer than one in 2.5 million live births.

In the riskiest part of the surgery, doctors had to separate blood vessels the two girls shared and decide which belonged to each child. That was followed by plastic surgery to extend each girl’s scalp to cover the area where they had been attached.

“A big cheer went up in the operating room – they were really excited when the separation happened,” Karpf said.

The two face still more operations to reconstruct their skulls.

Healing the Children, a nonprofit group in Spokane, Wash., had arranged to bring the sisters from Guatemala for the $1.5 million operation. “The whole country has come together for these kids,” said Naomi Bronstein, a volunteer with the organization.

Surgeons around the world have performed cranial separations only five other times in the past decade, and not all twins have survived.

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On the Net:

http://www.healthcare.ucla.edu/default.htm

http://www.healingchildren.org/welcome.html