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One of Two Separated Twins Back in Surgery to Stop Bleeding - 2002-08-06

Doctors who performed marathon surgery to separate twin baby girls from Guatemala, born joined at the head, are watching one of the girls, who developed bleeding in the brain.

The medical team numbering 50 huddled over the one-year-old twins for 22 hours at a University of California hospital, while delicately cutting through their skulls and disentangling two networks of fine blood vessels.

But within four hours, bleeding in the brain sent one of the sisters back into surgery to stop it. According to news reports, the doctors say the complication is not a surprise and that the outlook for the girl is positive. Both twins will remain under intensive care for several days.

The one-year-old girls had been connected at the top of their heads, facing opposite directions and had never looked at each other, face-to-face.

A physician who assisted the surgeons, Houman Hemmati, told NBC television's Today Show that the skull separation exposed the top of the babies' brains. The doctors refashioned bone and skin to cover them again.

Dr. Hemmati says most delicate part of the procedure was separating the interwoven blood vessels that ran between the heads. "The surgeons using several complicated techniques were able to determine which child was receiving better blood flow from each of the veins, sent the blood flow in that direction, and each child had enough blood flow going to it that they were able to separate," he explained. "So they didn't in fact create new veins. Instead, they rerouted existing veins to go to one child or another."

One of the twins required transfusions when she lost a lot of blood during the long operation, but the physicians were able to maintain normal blood pressure.

Otherwise, said Dr. Hemmati, there were no unforeseen complications. "Everyone had goosebumps at the end of the procedure," he added. "People were cheering, people were clapping, people were crying. It was more than optimistic. It was overjoyed, and we can't wait until we see these kids playing, laughing, crying like normal baby children."

A case like this is extremely rare. Attachment at the top of the skulls is the most unusual form of conjoined twins, occurring once in every two-and-a-half million births. Luckily, the babies shared no brain tissue, a factor that would have further complicated the procedure.