Doctors halt surgery on joined twins

One of the year-old girls unstable during operation

September 12, 2004|By David Kohn and Doug Donovan | David Kohn and Doug Donovan,SUN STAFF

Doctors at Johns Hopkins Children's Center temporarily halted surgery to separate 13-month-old conjoined twins last night after "metabolic complications" caused one of the girls' vital signs to become unstable.

The procedure was stopped about 8 p.m., a Hopkins spokesman said, more than 12 hours after Lea and Tabea Block were first wheeled into the operating room. A Hopkins spokesman said the twins were stable late last night and that surgeons likely will decide today when or whether to resume the delicate and complex operation.

According to hospital bulletins, surgical preparations began at 7:30 a.m. yesterday, with the first incision at 12:30 p.m., when plastic surgeons inserted expanders to protect the girls' scalp tissue, which must be stretched to cover the separated heads.

After that, neurosurgeons began cutting into their skulls. By about 5 p.m., doctors had cut through and opened the dura, the fibrous covering of the brain. They were working to separate the major blood vessels shared by the girls when one of the twins' vital signs became unstable.

Hopkins spokesmen did not reveal which twin became unstable, or what the specific instability was. The parents of the twins, who live in Lemgo, Germany, have signed an exclusivity agreement with the German newsmagazine Stern. They asked Johns Hopkins to release only minimal information to the news media until the completion of the surgery. A Children's Center spokeswoman said more information likely would be released this morning.

Surgeons have several options. They could halt the surgery altogether, deciding it is too risky. They could continue with the procedure as planned, attempting to complete it within the next 48 hours or so. Or they could opt to perform the procedure in sections, spread over several weeks. This last strategy is sometimes used in complex brain operations.

Lea and Tabea were born with craniopagus, a condition in which they're connected at the top of the head. The pair have individual brains, but share several cranial blood vessels. The condition occurs once in about every 2 million births.

Their case has made them celebrities in their home town, where thousands of residents have raised money to help finance the attempt to separate them.

They came to Baltimore to be operated on by a team of 50 surgeons and other medical specialists led by Dr. Benjamin L. Carson, head of pediatric neurosurgery at the Children's Center. He has performed the procedure four times previously, twice successfully.

The most recent attempt was in July last year in Singapore, where Carson was part of a team that tried to separate 29-year-old Iranian twins who were joined at the head. The operation hit unexpected snags, and Carson said afterward that he asked the twins' designated representative to halt the procedure.

But the surgery continued, and the women died of massive bleeding.

Carson also led a team in 1987 that separated 7-month-old boys from Germany, using for the first time a procedure in which their circulatory system was bypassed and their bodies were cooled to preserve brain function. In 1997, he led a team of South African doctors in the first successful separation of vertically conjoined twins.

Wire services contributed to this article.

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