Doctor: Lessons learned might save other conjoined twins
(CNN) -- A mysterious complication arose during marathon surgery this week to separate two Iranian sisters born joined at the head, prompting doctors to consider halting the surgery, one of the neurosurgeons on the medical team said Friday.
However, Dr. Benjamin Carson of the Johns Hopkins University said that the family of Ladan and Laleh Bijani was "adamant" that the separation surgery proceed.
Doctors at the hospital in Singapore where the surgery took place had also promised the twins before the procedure that the separation would be completed.
"At that point, I must say I felt like a person heading into a dark jungle [facing] a hungry tiger with no gun," Carson said at a news conference Friday afternoon at Johns Hopkins.
The 29-year-old twins died from severe blood loss related to the complication, he said. Ladan died first; Laleh succumbed 90 minutes later.
The two twins will be buried in separate caskets Saturday in Iran. The funeral was delayed one day because so many people wanted to pay their respects in their hometown of Lohrasb, 680 miles southwest of the Iranian capital, Tehran. (Full story)
Although Ladan and Laleh had separate brains, making separation possible, they shared a major vein. As part of the surgery, a vein was taken from another part of the body to create separate channels to drain blood from each twin's brain.
Carson said the new vein kept clotting off, but the brains remained soft -- indicating that blood flow was continuing through other channels. Because the medical team did not know how the blood was flowing, he suggested stopping the surgery to further study what was happening and revise the surgical plan accordingly.
After the family decided to proceed, doctors continued the meticulous separation process, eventually reaching the dura at the base of the brain, he said.
The Bijani twins first asked for separation surgery in 1988. |
The dura is a thin, leather-like material that covers the brain. But the dura at the base of the Iranian twins' brains was swollen by blood and about 10 times as thick as it should have been, he said.
Surgeons had found the alternate channel though which blood was draining. When they tried to cut the dura apart, the result was uncontrollable bleeding, which led to the women's deaths, he said.
Carson said the medical team does not know why the blood began flowing through the dura instead of the new vein. But he said that if he were to perform a similar operation in the future, the experience with Ladan and Laleh has taught him that the procedure should be done in several stages weeks apart -- which would enable doctors to keep the blood in controllable channels -- rather than trying to do the whole separation at once.
"It's a failure only if you don't get anything out of it," he said. "Thomas Edison said he knew 999 ways that a light bulb did not work, and yet we have lights today. There's a cleaning formula called 409. The first 408 didn't work.
"I think there will come a day when twins such as these can have a normal life and a safe separation. And I think Ladan and Laleh will have contributed very significantly to those individuals in the future who will in fact be able to enjoy what the aspiration of these two courageous young ladies was."
Carson also said that the sisters were fully aware of the risks associated with the surgery and knew that the odds of survival were only 50-50. But he said they were adamant that death was preferable to living joined at the head.
"They were amazingly cheerful and optimistic [going into surgery]," he said. "They knew that they would either come out separated or that they probably wouldn't suffer anymore. ... And that made them happy."
Because of medical complications associated with conjoined twins, the sisters would probably have not lived a normal life span if they had remained conjoined, Carson said.
The unsuccessful separation surgery lasted 53 hours, with doctors working in shifts, he said.
