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Swollen brain stops surgery on conjoined twins

/ Source: The Associated Press

Surgeons trying to separate 3-year-old conjoined twins halted the operation because of swelling in the brain of the larger, stronger girl, but the doctors and parents said Thursday that they would try again.

The parents of Tatiana and Anastasia Dogaru said in a statement released by the hospital that the girls were doing fine. The blond twins, born in Italy to Romanian parents, were awake and alert Thursday.

“We know the doctors are being cautious to keep the girls safe,” said Alin and Claudia Dogaru. “We want to thank you for your continued prayers.”

After a section of bone was removed Wednesday, doctors discovered that Anastasia’s brain tissue was swollen and her blood pressure lower than usual. When medications to reduce the swelling were ineffective, doctors closed the opening without starting the first operation to separate them.

“We remain hopeful that we can help the twins, but every procedure leads to new decisions, and that’s true for this one as well,” said Nathan Levitan, chief medical officer at University Hospitals Case Medical Center and the leader of the surgery team.

The medical team will conduct studies, including an MRI, to determine the cause of the swelling, then decide whether they can attempt the procedure again, Levitan said.

“Before the swelling can be treated, it’s important to understand what the cause is,” he said.

Asked whether he still had the cautious optimism he had expressed before the procedure, Levitan emphasized that doctors understood all along the twins were facing a long, difficult ordeal.

Already beaten the odds

The surgery, one of four procedures planned over several months, lasted 11 hours.

Dr. James Tait Goodrich of New York’s Montefiore Medical Center, who separated conjoined twins in 2004, said the interruption showed the advantage of doing surgery in stages instead of a marathon.

“You go as far as you can go, and you stop,” said Goodrich, who has consulted on the Dogaru case.

The swelling wouldn’t necessarily change prospects for future success, he said. However, “if you go back and the same problems occur again, then you have to reassess whether or how far you want to proceed,” he said.

Because the girls are linked, there may be a physiological reason for the swelling, Goodrich said. “There’s a lot of physiological dynamic going between the two kids. In a sense, each of them is supporting the other in one way or another,” he said.

Anastasia, who has no kidney function, relies on Tatiana’s kidneys and would need a transplant after separation.

The top of Tatiana’s head is attached to the back of Anastasia’s, and they have never been able to look directly at each other.

Twins born joined at the head — known as craniopagus twins — are rare, occurring in about one in 2.5 million births.

The girls have already beaten the odds by living this long. Most craniopagus twins die at birth, and just 10 percent survive to age 10, according to the hospital.

Alin Dogaru, a Byzantine Catholic priest, and his wife, both 31, have said they view the separation surgeries as the girls’ best hope. They arrived in Cleveland in April after 2½ years in Dallas.