Twin girls born joined at the head have overcome long odds, but the doctor who brought them to the United States to be evaluated for surgery now says there's no longer any chance they will ever lead separate lives.
Anastasia and Tatiana Dogaru, who will be 5 in January, were born in Rome to Romanian parents. The top of Tatiana's head is attached to the back of Anastasia's, meaning the girls have never been able to look each other in the eye.
Tatiana has had to undergo heart surgery. Anastasia has no kidney function and relies on Tatiana's kidneys.
However, the twins have become smart, active girls, said Dr. Kenneth Salyer, chairman and founder of the Dallas-based nonprofit World Craniofacial Foundation. Still, their long-term prognosis is uncertain.
"They're troupers and they may be with us a long time, God willing," Salyer said.
Physicians at Rainbow Babies & Children's Hospital in Cleveland had hoped to separate the girls, but that surgery was deemed too dangerous and was called off in August 2007.
Still, Salyer, whose foundation brought the girls to Dallas when they were babies, had kept up hope that separation might still be possible.
But no longer.
"We have finally decided that it's in these girls' best interest that they remain like they are and that's really hard for me to say because I've been optimistic about separation," Salyer told The Associated Press earlier this month.
He said attempts to find other medical centers to take the case were unsuccessful after the Ohio operation was called off.
Complications arose as girls got older
In addition, other complications arose as the twins grew older. One girl's brain is growing into the other's, making surgery impossible. Also, their brains' ability to recover from a separation surgery has diminished.
"As they've gotten older and they've grown and developed — it's now too dangerous to separate the children," Salyer said.
Twins born joined at the head — known as craniopagus twins — occur about once every 2.5 million births.
After Anastasia and Tatiana were born in 2004, doctors in Italy told the girls' parents, Claudia and Alin Dogaru, that nothing could be done for them.
However, the parents had heard about the successful separation in Dallas the year earlier of Egyptian twins joined at the head. Through his foundation, Salyer had brought Ahmed and Mohamed Ibrahim to Dallas and was part of the team of surgeons who performed the 34-hour surgery.
The Dogarus contacted Salyer and the girls came to Dallas in October 2004. Not long after arriving, Tatiana underwent heart surgery to fix a constriction of the main vessel of her heart — a defect that would have been deadly.
After more than a year, Salyer said a plan was developed for a separation surgery. "I had nothing that told me at that time that we couldn't do it," he said.
The next issue was finding a hospital for the surgery and the foundation hoped to find an institution that could donate the majority of the costs, said Sue Blackwood, foundation vice president.
Children's Medical Center Dallas, where the Ibrahim twins were separated, turned them down. It said that as a not-for-profit, it couldn't absorb the cost of every complex surgery and still serve its community.
Finally, Rainbow Babies hospital agreed to do the surgery, Salyer said. The plan was for Anastasia to undergo dialysis after the separation and then get a kidney transplant, likely from one of her parents.
'They don't have normal systems'
After the surgery was called off at Rainbow Babies, Salyer consulted three more centers but all three decided against taking on the surgery.
He said he told the girls' parents a couple of months ago that separation would be impossible. The family now lives in the Chicago area, where Alin Dogaru, a Byzantine Rite Catholic priest, has accepted an assignment at a parish. The parents declined to comment.
While they are doing well now, the girls' future is uncertain because of their complicated connection. Besides their joined brains, they also share blood vessels and don't have enough venous drainage, Salyer said. "They don't have normal systems," Salyer said.
"All of the medical issues in total, you can't say how these children are going to do," he said.
He said that based on today's medical capabilities, the girls cannot be separated.
"Nobody is going to go in there unless we get some new magical methods," Salyer said.