- The Washington Times - Monday, August 2, 2004

NEW YORK (AP) — If all goes well during a daylong operation Wednesday, Carl and Clarence Aguirre, 2-year-old twins from the Philippines joined at the top of their heads, will wake up in separate beds.

For the first time, they will be able to look at each other’s faces. They soon should be able to sit up, stand straight and walk for the first time — no longer the toddlers who couldn’t toddle.

“I can’t wait to see how they react,” said Dr. David Staffenberg, the plastic surgeon on the team that plans to separate the boys at Montefiore Medical Center in the Bronx. “I can imagine them looking at each other and thinking, ‘I know that guy, but how come he’s over there?’”

Since the past year, Carl and Clarence have been the focus of a determined effort by their mother, Arlene Aguirre, as well as two hospitals and a medical team donating their services. The doctors have taken a surgical approach employed rarely on conjoined twins, replacing the typical marathon two-day operation with four shorter procedures over 10 months.

The aim is not only to ensure survival of both boys — often one twin dies — but also to increase their long-term chances without major complications.

Still, Dr. Staffenberg said, success is “very far from a done deal. There’s lots that could go wrong.”

In previous operations, the boys’ skull was opened, the separate-but-touching brains carefully pushed apart and most of the shared blood vessels cut and divided. Magnetic resonance imaging shows that the boys now have nearly equal, thriving circulation systems, said lead surgeon Dr. James Goodrich.

Previously dormant veins on Carl’s side have plumped up and assumed the duties of veins on Clarence’s side that had been doing the circulation work for both boys.

Like those operations, the fourth one Wednesday will be alarmingly delicate.

Dr. Goodrich and Dr. Staffenberg will cut through skin and bone to open a window on the brains and the surrounding blood vessels. The major vein the boys still share will be cut and divided.

The last area where the brains are touching — about 1 inches across, Dr. Staffenberg said — will be teased apart while doctors keep an eye out for any connecting veins.

It’s difficult work, even with the help of magnifiers. The surgeons have described the tiny veins as having “the consistency of wet toilet paper.”

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