- The Washington Times - Sunday, January 27, 2002

CAIRO Conjoined twins who are vertically joined at the head are to undergo a pioneering separation operation this week.
At 7 months of age, the Egyptian twins, Ahmed and Mohamed Ibrahim, will be the youngest ever to undergo such separation surgery. An early operation is necessary because doctors are worried about the possible effects of one of the rarest known types of fusion.
Only two other pairs of so-called Siamese twins are known to have been joined at the tops of their skulls rather than at the temple, according to medical records. In these circumstances, it becomes impossible for conjoined twins to live active lives because they are unable to stand or move about.
After consultations among Egyptian doctors and medical specialists from around the world, the twins are to be operated on by surgeons at the North Texas Hospital for Children in Dallas, one of the leading centers for craniofacial surgery.
There they will begin a painstaking process during which doctors will spend two months stretching skin on their skulls so that extra flaps can be used to cover the exposed parts of their heads after the operation.
Three-dimensional images of the inside of the babies' heads will also be produced using the latest scanning technology to help the specialists to plan and conduct the surgery. Dr. Nasser Abdelal, director of the Neonatal Surgical Unit at Cairo University's Pediatric Hospital, said: "My team and I will accompany the twins to the U.S., but we trust our American colleagues to make the right decisions about their welfare."
The two babies have individual brains but share a large cerebral vein and a bridge of brain tissue. It is not known what effect the separation might have on later mental development.
Last year, doctors in Singapore spent 97 hours completing the world's first successful operation of this kind, on Nepalese twins whose birth defects resembled those of their Egyptian counterparts. The Ibrahim twins, however, are more than three months younger than the Far Eastern pair were at the time of surgery. The only other recent known case of vertical fusion occurred in South Africa, but neither baby survived beyond early infancy.
"Death is a secondary concern right now," Dr. Abdelal said. "We want to exhaust all the options available to us, and if death becomes inevitable then we will have no regrets because we tried our best."
The twins, who were born to a poor family in the Egyptian town of Qena, have seen their parents only a few times since their birth in June last year. Concentrating on the struggle to feed their other children, the Ibrahims decided to make Dr. Abdelal the twins' legal guardian.
Ahmed and Mohamed together weighed a healthy 13.2 pounds when they were born by Caesarean section. They eat and sleep independently of one another, cared for by 10 nurses. Both babies smile regularly and are responsive to a steady stream of medical visitors. They lie in a specially constructed cot, with a central pillow on which they rest their heads.
During surgery, the Dallas doctors will separate the twins and then use synthetic material, moulded into the shape of a skull, to cover the denuded areas in their heads. This false bone will then be covered with the stretched skin flaps.
"If the twins survive then we hope donations would allow us to move their family to Cairo so they can be reunited with their parents. This would also enable us to keep an eye on their medical welfare," Dr. Abdelal said. "Doctors are used to looking death in the face, but our unit is very attached to these babies. We all hope that this pioneering operation will be a success."

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