Surgeons in New York City took their first look inside the skulls of Filipino boys joined at the tops of their heads and said they found nothing to dissuade them from continuing with a monthslong separation process.
The 18-month-old twins, Carl and Clarence Aguirre, endured Monday's operation well, the doctors said.
"We were mainly looking at crossover between the blood vessels," said Dr. James Goodrich, who led a team of 20 in the 51/2-hour operation at the children's hospital of Montefiore Medical Center in the Bronx. "We did not find much, and that's a very good sign. There were no surprises."
It was the first of at least three planned operations.
Goodrich removed a piece of skull bone to expose the upper surface of each boy's head and give doctors a view of their brains and blood vessels.
"It's like a window," he said in describing the procedure last week.
The doctors had seen three-dimensional models, video simulations and scores of MRI scans, but the skull opening gave them their first real look at the area that is likely to occupy their attention until Christmas.
Using tiny titanium plates and screws, the skull was reassembled, and then Dr. David Staffenberg inserted two inflatable "tissue expanders" under the twins' scalps to gradually stretch their skin so there will be enough to cover their heads when they are separated.
The doctors also divided a few superficial veins, said hospital spokeswoman Pamela Adkins.
Staffenberg said, "Everything went absolutely smoothly."
The boys, still joined, will be given a couple of weeks to heal and adapt before the next operation. The agenda for that surgery will be determined by how the boys react to Monday's procedure.
The most difficult surgery will involve the sagittal sinus, a major vein that drains blood from the brain to the heart. The boys have only one, and the doctors plan to assign it to one twin and reroute other veins to replace it in his brother.
Goodrich said he decided against one marathon separation operation to help the boys adapt slowly to rerouted circulation systems and to avoid lengthy anesthesia and the risk of major blood loss. It was blood loss that killed two Iranian sisters who underwent separation surgery in Singapore in July.
Twin 2-year-old brothers from Egypt, joined at the head like the Aguirre brothers, were separated in one long operation Oct. 11-12 in Dallas and are recovering well.
