Conjoined at the head twins separated in New York

Surgeons at a New York City hospital on Friday separated a pair of 13-month-old boys who were congenitally joined at the head, completing a rare operation that carried a risk of death and severe brain damage.

Jadon and Anias McDonald of Coal City, Illinois, underwent 16 hours of surgery at the children's hospital at Montefiore Medical Centre in the Bronx before the surgical team, led by Dr James Goodrich, fully detached their skull and brain tissue, the boys' mother, Nicole McDonald, wrote on Facebook.

While the twins survived the surgery, the outlook for their health is unclear.

“We are standing on the brink of a vast unknown,” Ms McDonald wrote.

“The next few months will be critical in terms of recovery and we will not know for sure how Anias and Jadon are recovering for many weeks.”

High-tech modelling was used to help the surgeons separate the brothers, but the vasculature involved in the procedure was more complex than the images showed, Ms McDonald said.

During the operation, surgeons found a 5x7cm area of brain tissue with no clear line of dissection.

“Dr Goodrich had to make the call and the final cut based on his instinct,” Ms McDonald said.

Anias, who remained in surgery longer than Jadon, appeared to suffer more than his brother following the separation of the brain tissue.

The boy, whose heart rate and blood pressure dropped during the operation, is being monitored for brain swelling and stroke, Ms McDonald said.

He is expected to suffer some type of paralysis during his recovery.

Jadon “hardly batted an eye through the whole procedure in terms of maintaining his vitals”, Ms McDonald said.

Monitoring

The twins, who also underwent skull reconstruction on Friday, will be intubated for about a week while their brains and vital signs are monitored.

About one in 200,000 births produce conjoined twins, with about half arriving stillborn and about one-third surviving a single day, according to the University of Maryland medical centre.

Success rates in surgical separation are similarly dismal and depend on the point of connection.

For instance, 68 per cent of twins joined at the base of the spine have been successfully separated, while there have been no known separation survivors of twins who were connected at the heart, the medical centre said.

“We just took a huge leap of faith,” Ms McDonald said. “I’m still frozen in space and time . . . I’ll be hanging out there until I see those smiles again.”

Reuters