Formerly conjoined twins in critical but stable condition

Doctors remain “cautiously optimistic” about the
condition of Maria Teresa and Maria de Jesus Quiej Alvarez, who
remain in critical but stable condition with vital signs in the
Pediatric Intensive Care Unit at UCLA’s Mattel
Children’s Hospital in Westwood.

Both girls remain under sedation and are responding to
stimulation, according to Dr. Andy Madikians, assistant professor
of pediatrics at the David Geffen School of Medicine at UCLA and
PICU.

“We remain cautiously optimistic about the long-term
prospects of both girls,” Madikians said. “Things are
going the way they should.”

But Madikians warned it is still too early to tell if the twins
will recover successfully.

“There are still a lot of hurdles we need to cross,”
Madikians said Sunday.

Doctors began administering nutrition intravenously to the twins
on Aug. 9.

The girls are able to open and close their eyes, and Maria de
Jesus is able to look around when she opens her eyes and move her
arms and legs slightly.

The other sister, Maria Teresa, underwent a two-part, five-hour
surgical procedure after the initial surgery to correct a subdural
hematoma, or a build-up of blood in the brain, and is recovering
more slowly.

“Maria de Jesus is a little more responsive than Maria
Teresa,” Madikians said. “It’s possible that
Maria Teresa is a bit behind her sister because of the follow-up
surgery.”

UCLA doctors successfully separated the one-year-old formerly
conjoined twins after a 23-hour surgery involving more than 40
health-care professionals on Aug. 6.

Dr. Henry Kawamoto, surgical director of the UCLA Craniofacial
Clinic and the chief plastic surgeon, stressed the success was a
result of a team effort.

“Everything went off like a symphony,” Kawamoto
said. “The anesthesiologists were fabulous, (and) the
neurosurgery team was very professional.

Doctors prepared the girls for the separation on June 24 by
threading two eight-inch long silicone balloons under each
girl’s skin, near the groove where their heads were
joined.

Doctors inflated the balloons by injecting saline solution into
them, causing the twins’ skin tissue to stretch and expand
enough to cover the backs of their heads after separation
surgery.

During last week’s surgery, Kawamoto made the initial skin
incision after the twins were sedated ““ a lengthy and
complicated process.

Once the initial incision was complete, a team of neurosurgeons
then removed the shared portion of skull the twins shared and
separated two major veins that connected the front of each
girl’s head to the back of the other’s.

Kawamoto then closed the wound, using the babies’ skin
previously stretched from saline-injected balloons underneath their
skin.

Kawamoto expects the girls to look normal once they recover. For
now, there are areas of their heads with no hair, because doctors
shifted areas of their scalps to cover the large wounds. However,
this can be corrected by stretching areas which do have hair,
according to Kawamoto.

The twins, who celebrated their first birthday three weeks ago,
are originally from Guatemala and arrived at UCLA with their mother
Alba Leticia Alvarez, 23, on June 7. Their father, Wenceslao Quiej
Lopez, 21, remained in Guatemala until Aug. 3 when he arrived in
Los Angeles to be with the family.

Dr. Jorge Lazareff, the chief neurosurgeon, originally lobbied
to have the children brought to UCLA from Guatemala through Healing
the Children, a nonprofit group which finds medical care for
children in developing nations.

The Medical Center accepted the case for humanitarian reasons,
as well as for teaching and learning opportunities, a hospital
statement said.

Doctors have performed cranial separations only five times in
the last 10 years, and not all twins have survived. This was the
first time the procedure happened at UCLA.