Doctors in Dallas, Texas, continue to monitor the recovery of two-year-old twins from Egypt, who were joined at the head until surgeons separated them in a two-day operation that ended Sunday. The two little boys will remain in a drug induced coma for the next day or two, in order to allow their cranial tissue to heal.
Speaking to reporters at the Children's Medical Center in Dallas, Doctor James Thomas, chief of Critical Care Medicine, described the twins' condition as "truly remarkable."
He said both Mohammed and Ahmed Ibrahim remain asleep in a barbiturate-induced coma, to promote healing from the operation. Dr. Thomas said surgeons are monitoring the twins for signs of brain swelling or infection, and will slowly bring them out of the coma in the coming days. "The plan, as it stands now, is probably, in the next two-and-a-half to three days, to begin to decrease the dose of [medication] and see how they respond. If they respond favorably, then we would continue to drop the dosing of that medication," he said.
Keeping the boys in a coma with barbiturate also produces complications. Doctor Thomas said other drugs must be used to keep the patients' blood pressure from falling too far. "The barbiturate that is used to put them into a drug-induced coma actually decreases the ability of the heart to pump as strongly as it would, and so the [other] medication is used to counteract it, it allows the heart to pump more strongly," he said.
Doctors will not be able to fully evaluate the success of the operation, until both boys are awake and can respond to tests. One concern is that the delicate operation to separate their brains could result in some neurological damage to one or both of them.
Doctor Thomas said both parents have been close to the boys and the medical team during the procedure, and that both mother and father are in good spirits.
The two boys were born joined at the top of their heads in a small village 800 kilometers south of Cairo in June 2001. Since June of last year, they have been living in Dallas, so doctors could study them closely.
The effort to separate them was sponsored by the Dallas-based Cranial-Facial Foundation, a non-profit group that assists children with deformities of the head. Around 60 medical professionals, including neurosurgeons and plastic surgeons, donated their time and expertise to the effort. The operation to separate the twins took 26 hours and was followed by several hours of work to restore their skulls and close their wounds.