Boys from Philippines healthy enough for separation surgery in New York, doctors say

The Associated Press
10/17/03 2:11 AM

NEW YORK (AP) -- A set of 18-month-old twin boys from the Philippines joined at the top of their heads have gained enough weight and are ready for a separation process involving multiple surgeries that could take several months, doctors said.

The goal is for Carl and Clarence Aguirre "to live viable, independent lives," Dr. James Goodrich, director of pediatric neurosurgery at Montefiore Children's Hospital in the Bronx, said Thursday. The first operation was scheduled for Monday.

The boys' brains appear to be almost entirely separate within their fused skulls, though they share major veins that must be divided.

"We believe that we can do this, but at the same time we are cognizant of the risks," Goodrich said. "We're aware that we could lose one or both."

Outwardly, the boys look much like the Egyptian twins who were separated in a 34-hour operation in Dallas last weekend. But Goodrich has said that case was more complex because the Aguirre boys' brains are believed to be less intertwined.

Instead of one long operation to separate the twins, Goodrich and Dr. David Staffenberg plan about three, with several weeks between each.

Goodrich said he decided against marathon surgery to help the boys adapt slowly to their rerouted circulation systems and to avoid lengthy anesthesia and the risk of major blood loss.

The trickiest maneuver may be severing a major vein called the sagittal sinus, which drains blood from the brain to the heart. It appears the boys have only one between them, so it will be assigned to one of them and the doctors will try to redirect other veins to act like the sagittal sinus in the other twin.

The twins, who live on a sugar plantation outside Silay City, would be toddlers if they could walk. But they have spent their entire lives lying down. Feeding the boys is difficult because of the danger of choking. When they are carried, it is by two people standing or walking side-by-side.

With their mother, Arlene, a 31-year-old nurse, they came to America on Sept. 10 and have been staying at Blythedale Children's Hospital in Valhalla. While undergoing physical therapy, dental work and treatment for Clarence's hypertension, they have grown from a severely underweight 25 pounds combined to 32 pounds, said Dr. Joelle Mast, chief medical officer at Blythedale. At birth they weighed 8 pounds.

"Both of these kids are in wonderful physical condition right now," Goodrich said.


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