LOS ANGELES -- The Guatemalan twins who spent the first year of their lives joined at the head were reported doing well Wednesday, their first full day as physically separate sisters.
Maria Teresa Quiej Alvarez and her twin, Maria de Jesus, were sedated and remained in critical condition at the University of California, Los Angeles Medical Center. The 1-year-old girls, separated in a nearly daylong operation that ended early Tuesday, were expected to use breathing tubes for days.
"Both children are sedated, but their vital signs are just where we want them right now," Dr. Henry Kawamoto, one of the surgeons who took part in the operation, said on CBS's "The Early Show" on Wednesday. "We just have to wait until they get over the effect of the long operation."
Early Tuesday, after the separation was completed, Maria Teresa was returned to surgery because of a buildup of blood on her brain, said Dr. Jorge Lazareff, the lead neurosurgeon. Nearly five hours later she was out of surgery again and back in the pediatric intensive care unit.
The second operation was not expected to have any effect on Maria Teresa's long-term prognosis, Lazareff said.
"I'm absolutely positive they will do OK. I'm absolutely positive if you go and visit them in five years they will be leading a normal life," Lazareff said.
Dr. John Frazee, another neurosurgeon, said it remained to be seen whether the girls suffered any brain damage following 22 hours of surgery.
"They're moving, which is a good sign," he said Tuesday. "There's no way of knowing what the state of affairs is for another week."
There was no word from the parents, Wenceslao Quiej Lopez and Alba Leticia Alvarez. The mother spent eight days in labor at home in July 2001 before delivering the twins in a hospital by Caesarean section.
Lazareff said that after the separation surgery, Alvarez said: "It's in the hands of God. It's God's will."
Although a medical center official had said there was cheering after the moment the twins were separated, Kawamoto, a plastic and reconstructive surgeon, said there was no celebration then.
"The separation occurred and we just went on to the next step," he said.
The girls were 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.
The riskiest part of the surgery was the separation of the veins that connected the girls' heads.
Surgeons at UCLA's Mattel Children's Hospital had to separate the individual blood vessels the two shared and decide which belonged to each child. Rerouting the flow of blood to and from the brain of each child put both at risk for stroke, UCLA neurosurgeon Dr. Itzhak Fried said.
Plastic surgery was then performed to extend the scalp of each child to cover the portion of exposed brain where they had been attached. The two still face follow-up surgeries to reconstruct their skulls.
Surgeons around the world have performed cranial separations only five other times in the past decade, and not all twins have survived.
Healing the Children, a nonprofit group in Spokane, Wash., had arranged to bring the sisters from Guatemala for the $1.5 million operation.
On the Net:
UCLA Healthcare: http://www.healthcare.ucla.edu/default.htm
Healing the Children: http://www.healingchildren.org/welcome.html
Brainerd Dispatch ©2013. All Rights Reserved.