- The Washington Times - Saturday, November 30, 2002

DALLAS The father of 17-month-old Egyptian twins conjoined at the head is considering an extremely delicate operation that would separate the two boys.
The boys, Mohamed and Admed Ibrahim, were brought to Dallas earlier this summer for evaluation by the World Craniofacial Foundation, and physicians have been conducting tests on the pair. The operation would take place in a few weeks.
"Nothing final has been determined yet," said Sue Blackwood, executive director of the foundation.
Dr. Kenneth Salyer could not be reached for comment this week. He is the lead doctor for a team of about 50 looking into the operation. Ten to 15 doctors from the team are likely to be present if the operation is performed.
Several sets of conjoined twins have been separated in recent years, but few where the two were so dependent on each other as the Ibrahims.
"We are doing everything we can to get them into the best position for surgery," Dr. Salyer said a few weeks ago.
"The final decision will be up to their father," he added.
The foundation flew their father, Ibrahim Mohamed Ibrahim, to Dallas several weeks ago to get acquainted with the boys and help decide on the preparations for the operation.
The twins live in an apartment near Medical City Hospital in North Dallas, where the World Craniofacial Foundation is based. Two Egyptian nurses have cared for the boys since shortly after their birth in June 2001.
Surgeons familiar with the proposed separation say that one or both of the boys could die but that if they stay connected, they would require lifelong care and would probably never walk because of the way they are conjoined.
Less than 2 percent of all conjoined twins are joined at the crown of the head as these children are, said Mrs. Blackwood.
The main problem is that the two boys share the main vessel that drains blood from the brain, which Dr. Salyer said "really complicates surgery options."
Mrs. Blackwood said Dr. Salyer was involved 15 years ago in a similar operation, where two Lithuanian girls were attached at the cranium, "but they didn't share the sagital sinus. They did not have nearly the situation that these two have."
Another challenge, Mrs. Blackwood said, is to develop enough skin to cover their heads after the separation. She said doctors expect that it would take as long as two months of using "tissue expanders," balloons that are inflated to expand and stretch the skin.
Some nurses say the boys are "as well adapted as they could possibly be under the circumstances" and seem relatively happy. They are often taken out by the caretaker nurses to shopping malls and parks.
The foundation, a decade old, has agreed to pay for all expenses, travel, housing and professional care.
The boys' mother has remained in Egypt to care for the couple's other two children, ages 4 and 6.
In August, 1-year-old twin girls from Guatemala were successfully separated in Los Angeles. They are still hospitalized but are recovering well, according to reports from Mattel Children's Hospital at the University of California.


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