US surgeons were forced to halt a delicate and high-risk procedure to separate twin girls joined at the head because of unexpected brain swelling, doctors said Thursday.
Three-year-old Anastasia and Tatiana Dogaru, whose parents are from Romania, were described as "medically stable" at Rainbow Babies and Children's Hospital in Cleveland, Ohio, after a first round of surgery Wednesday to begin separating their skulls.
But doctors were hesitant to go further until they determined the cause of the swelling in the dominant twin, Anastasia, which was discovered after neurosurgeons took out a section of skull to expose the brain tissue.
"After removing the bone, it became apparent that the brain tissue was swollen, despite the fact that measures had been taken to prevent such swelling," chief medical officer Nathan Levitan told a news conference.
"They felt that it would not be safe to cut into the brain tissue or the surrounding blood vessels in any way, without first understanding the cause of the swelling and the low blood pressure," Levitan said.
"As a result, they decided not to continue with surgery at that time," he said, adding that an MRI and angiogram would be studied to determine the next step.
The twins have never looked one another in the face, because the top of Tatiana's head is attached to the back of her sister Anastasia's head. Their brains are connected "in a complex fashion," and they also suffer from heart, organ and limb defects, a hospital statement said. Their condition, known as total angular craniopagus, is extremely rare and considered fatal without treatment, comparable to being diagnosed with a malignant, inoperable brain tumor, it said.
Pre-operation procedures began last month when doctors inserted wire coils into brains' blood vessels to create independent circulation for each child. The girls share the same circulatory system, so that any medication administered to one affects the other. Doctors feared that as the girls grew, the risk of one getting sick could endanger both of their lives. "There is a sense of urgency, because if one twin were to become severely ill and die, the other twin would most likely die within minutes or hours of the first.
The longer the twins remained conjoined, the more likely it is that one will become ill," the hospital said. Doctors noted that the girls were fortunate to be alive since most cranial conjoined twins die at birth and only 10 percent live until the age of 10, but admitted it was "a very high-risk surgery in which one or neither of the twins may survive."
The twins' parents, Claudia and Alin Dogaru, both 31, brought the girls to the United States from Rome, Italy, where they were born, after seeing a news story about Egyptian conjoined twins who underwent successful separation surgery in Dallas, Texas.
Physicians on the 50-member medical team at the Cleveland hospital were donating their time, and other costs were being covered by donations and absorbed by the hospital, spokeswoman Janice Guhl said.
The parents were "in good shape" after their daughters' surgery and "thankful to the physicians for being cautious," Guhl added. Tatiana, the twin who is attached to back of her sister's head, is the weaker one and also suffers from abnormal heart vessels.
She was born with an enlarged heart, has high blood pressure and must wear leg braces because of her unusual positioning behind her sister.
Anastasia is missing one kidney and her other kidney does not work, so she relies on Tatiana's kidneys. Anastasia suffers from low blood pressure and also has what is known as a hypoplastic bladder, so she does not produce urine. However, both girls can walk, play and talk.
Craniopagus twins occur in one on 2.5 million births.
Egyptian twins Mohammed and Ahmed Ibrahim, who were attached at the head, successfully underwent separation surgery in 2003, and Guatemalan twin girls Maria de Jesus and Maria Teresa Quiej Alvarez survived similar surgery a year earlier. However, not all attempts have succeeded. Among them, one German conjoined twin died in 2004 after separation surgery from her sister, and 29-year-old Iranian conjoined sisters bled to death after the surgery in 2003.