- The Washington Times - Monday, October 13, 2003

DALLAS — Two-year-old Ahmed and Mohamed Ibrahim slept in separate beds for the first time last night as craniofacial surgeons worked to reconstruct their skulls after delicate neurosurgery that separated the Egyptian twins who were born joined at the head.

“The boys right now are medically stable,” Dr. Kenneth Shapiro, one of the neurosurgeons, said at a news briefing yesterday evening at Children’s Medical Center.

“We’re still completing the skin closure on them,” he added.

“Our plans basically are to keep them in a medically induced coma for several days, so at this point we can say that their vital signs are stable and we don’t see any sign that there had been any medical problems,” he said.

The actual separation, reattaching and rerouting of delicate areas of their brains — finished about 11:17 a.m. Dallas time — was the crucial portion of the operation, doctors here said.

Asked how many such vessels had to be cut, Dr. Shapiro replied, “We clipped just enough to separate them.”

The most difficult part of the operation, one doctor said at the news briefing, was separating the two brains, which were closer together than anticipated and “very, very stuck together.” Usually, he explained, in such cases the brains will peel apart easily once the neurologist reaches that area.

A team of five pediatric surgeons worked throughout the night Saturday and managed to avoid complications such as brain swelling, blood pressure or breathing problems or extensive bleeding.

“It was a night of long and hard work, but a night when everything went according to what was expected,” said Dr. Jim Thomas, chief of critical care at the hospital.

One of the anticipated factors doctors faced, said Dr. Thomas, was that blood vessels that might have been undetected on preparatory brain scans could interfere with their plans.

The operation was one of the most difficult ever. Conjoined twins occur only once in 2 million births and those conjoined at the head are only 2 percent of those. Ahmed and Mohamed were joined right at the crown.

Earlier yesterday, after positive reports from the operating room, Dr. Thomas added: “They are not out of the woods by any stretch of the imagination.”

Dr. Kenneth E. Salyer said he felt the neurosurgeons involved deserved the most praise for “their persistence in developing a plan that would eventually work.”

Half of the 60 children who have undergone similar operations died and 17 others suffered neurological impairment to some degree.

Dr. Shapiro said it was too soon to determine what, if any, neurological damage would result from the operation.

Doctors here had separated 10 other sets of conjoined twins in the past 25 years. Each case was considered successful, said Dr. Ted Votteler, a retired pediatric surgeon at Children’s who was involved in seven of them. In each case, one or both survived, he added.

The twins, sons of an Egyptian couple from a small town some 500 miles south of Cairo, were born June 2, 2001. They were brought here more than a year ago through the efforts of the Dallas-based World Craniofacial Foundation, a nonprofit organization that has helped children with head and facial deformities for many years.

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