Conjoined twins to undergo surgery

By David Zisser
Daily Bruin contributor
[email protected]

  Courtesy of UCLA Health Sciences Communications

Conjoined twins Maria de Jesus and Maria Teresa will be
surgically separated on Aug. 5 at UCLA.

UCLA doctors will perform surgery to separate 1-year-old
conjoined twins Maria Teresa and Maria de Jesus Quiej-Alvarez on
Aug. 5.

The Guatemalan twins, who are connected at the head, share a
portion of veins running from their brains. Instead of sending
blood from the brain back to the heart, some veins send the blood
from one girl to the other. The doctors must reroute those veins,
or both girls may be at risk for stroke.

The $1.5 million surgery, which UCLA is performing for free, is
expected to last between 10 and 14 hours. It will involve more than
50 medical staff, including neurosurgeons, plastic and
reconstructive surgeons, anesthesiologists and nurses.

“We are highly optimistic that the outcome will be
good,” said Dr. Jorge Lazareff, the lead neurosurgeon.

On June 24, doctors surgically implanted two balloons under the
babies’ scalp in order to expand their skin before the
separation. One balloon implant caused a thin tear in the skin,
making it useless. The doctors then injected the other balloon with
saline, causing the tissue to stretch.

Doctors have now determined the skin to be sufficiently
stretched to provide adequate coverage of the skull once the twins
are separated during surgery.

The surgery involves three phases: anesthetic preparation,
neurosurgery and plastic surgery.

Anesthetic preparation could take up to two hours because of
complications which could arise from the twins shared blood
flow.

Dr. Henry Kawamoto, Jr., the chief plastic surgeon, will make
the initial skin incision.

Three neurosurgeons will then cooperate in removing the part of
the skull the twins share, then expose the brain underneath. This
will allow the neurosurgeons access to the shared veins, which they
will cut and divide.

Kawamoto will then close the wound, using the skin previously
stretched by the saline-filled balloon.

If the surgery is successful, the twins should recover in about
two weeks, according to Kawamoto.

After the surgery, they will be transferred to the pediatric
intensive care unit at the Mattel Children’s Hospital at
UCLA.

The twins celebrated their first birthday two weeks ago at the
Children’s Hospital. They were originally brought to UCLA
from Guatemala through Healing the Children, a nonprofit group
which finds medical care for children in developing nations.

Cris Embleton, the executive director of the California chapter
of HTC and the person responsible for bringing the twins to UCLA,
is convinced they are in good hands.

“(The doctors’) skill level is top notch, but their
ability to administer the emotional part … is really a big plus
for us,” Embleton said.

“The girls are precious little beings you can’t help
falling in love with,” she added.

Both Kawamoto and Lazareff have had a chance to spend a
significant amount of time with the twins.

“The kids are lovely little kids, cute as hell. They smile
and laugh,” Kawamoto said.

The twins are “in excellent condition, lovely, trying to
stand up. They say “˜bye-bye’ in English,”
Lazareff added.

Lazareff, who is from Argentina and is fluent in Spanish,
lobbied to have the children brought to UCLA. He has spoken with
the twins’ mother, Albaletecia Alvarez, on a number of
occasions.

“She’s hopeful, very devoted and religious,”
Lazareff said of the mother.

“She’s aware of the risks of losing both of the
children, a remote possibility, but she also understands that they
can’t live like this,” he added.

Craniopagus twins ““ twins joined at the head ““ are
the rarest type, making up only two percent of conjoined twins.
Doctors have performed cranial separations only five times in the
past 10 years, and not all twins have survived.

But Lazareff remains optimistic.

“For me, the surgery … will end only when the children
smile back at us,” Lazareff said.