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No surgery planned for two-headed baby

Robin Wulffson MD's picture
conjoined twins, Siamese twins, surgery, Jesus, Emanuel

SAO PAULO, BRAZIL - Actually, the term “two-headed baby” is not entirely correct. The infants born Monday, December 19 are conjoined twins; their bodies are fused together and their heads are separate. (Conjoined twins are also known by the lay term “Siamese twins.”) The twins, Jesus and Emanuel were delivered by emergency cesarean section in Anajas, in the northeastern Para State in Brazil. The twins have two functioning brains and two distinct spinal cords; in addition, they share several internal organs.

Despite their situation, they are in stable condition. The twins were named Jesus and Emanuel in honor of the upcoming Christmas holiday.

Conjoined twins with lesser degrees of fusion have been surgically separated with survival of both twins. Examples include twins joined at their hips or the top of their heads. The degree of intermingling of bodily structures makes any attempts at separation extremely unlikely. “It is impossible to take a decision with relation to surgery, not only because of physical reasons, but ethical ones as well,” Dr. Neila Dahas of the Santa Casa de Misericordia Hospital said. "It's important to understand that this is two babies and not one baby with two heads.”

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Identical twins are the result of one ovum (egg) dividing after fertilization. On rare occasions, this division is incomplete: conjoined twins are the result. The present case is an example of a type of conjoined twins known as dicephalic parapagus twins. In 1990, Abby and Brittany Hensel were born in Minnesota. They are also dicephalic parapagus twins. They are currently in good health and living a reasonably normal life.

Another case of conjoined twins were born 10 years ago in Guatemala. They illustrate the triumphs and pitfalls of surgery for conjoined twins. They were called "Las Dos Marias," the two Marias, playful 11-month-old twins from Guatemala who were born joined at the head. Nine years after a 23-hour operation at UCLA freed them to live their own lives, they are no longer UCLA patients; however, the two surgeons who so famously separated them are still tenuously tethered to the girls. Last August, the two surgeons, Dr. Jorge Lazareff and Dr. Henry Kawamoto Jr., along with UCLA anesthesiologist Dr. Van De Wiele, joined celebrants at the girls’ lavish, luau-themed 10th birthday party at a private home in Malibu, hosted by Mending Kids International, the organization that now supports the twins’ care and helps thousands of children from developing countries receive corrective surgeries. Mending Kids International supporter, actor Mel Gibson, also attended the party.

Throughout the last nine years, both surgeons have attended birthday parties for the twins, who now live with host families in Southern California. They have watched the twins move in very different directions. The twin who was smaller as an 11-month-old, Maria de Jesus (now called Josie), will enter the fourth grade at a local public school this fall. She loves playing with friends and performs with a synchronized swim team; however, she needs assistance to walk. Her less fortunate sister, Maria Teresa, nicknamed Teresita, suffered brain damage as a result of contracting meningitis in 2003 in Guatemala. She does not walk or speak, although she manages to communicate non-verbally with those closest to her.

While the two girls are being raised in Southern California, their parents, Alba Leticia Alvarez and Wenceslao Quiej Lopez, visit a couple of times a year. Within four months of their return to Guatemala, "It became apparent that their fragile medical conditions were too challenging for their family and physicians in Guatemala to handle," said officials with Mending Kids International in a statement. "They were quickly returned to the United States to be treated and it became imperative for the well-being of the girls to live close to the necessary medical facilities in the United States." The outcomes have left those so intricately involved in that landmark operation performed at Mattel Children’s Hospital with a bittersweet aftertaste.

"It’s sad about her sister," said Kawamoto, a plastic and reconstructive surgeon who operated on the twins along with Dr. Jorge Lazareff, director of pediatric neurosurgery at UCLA. "But it could have happened to anybody." Kawamoto said he believes the meningitis was not attributable to the medical care they received in Guatemala. "It was the bad luck of the draw."