Conjoined Twins Die During Separation Surgery

TheGuitarist · July 8, 2003, 09:51

Quote:

Iranian Twins Die in Separation Surgery
By DARCY DORAN Associated Press Writer
published 09:32 AM - JULY 08, 2003 Eastern Time

Iranian twins Laleh and Ladan Bijani, joined at the head for 29 years, died within 90 minutes of each other Tuesday after doctors separated them but were unable to control their bleeding in the unprecedented surgery.

In their homeland, people cried out in shock or wept as state television broke into normal programming to announce their deaths during the third day of surgery in Singapore.

"Is my beloved Ladan really not with us anymore?" Zari Bijani, an elder sister of the twins, said after Ladan's death was reported. Seconds later, she fainted.

Hospital officials said Ladan died 90 minutes ahead of her sister Lelah, with both deaths because of blood loss. They died while still under anesthesia.

"Everyone upstairs is crying," said the nurse, speaking on condition of anonymity. "We treated them like family because they had been here for seven months."

It was the first time surgeons tried to separate adult craniopagus twins _ siblings born joined at the head. The surgery has been performed successfully since 1952 on infants, whose brains can more easily recover.

The risky, marathon separation procedure began about 10 p.m. EDT Saturday. Before the operation, doctors warned that the surgery could kill one or both of the twins, or leave them brain-dead.

"When we undertook this challenge, we knew the risks were great. But we were hopeful. Ladan and Lelah knew the risks too," said Dr. Loo Choon Yong, chairman of Raffles Hospital. "As doctors there is only so much we can do as the rest we have to leave it to the Almighty."

From the start, doctors ran into unexpected obstacles not found in the infants that the operation has until now been performed on. It took longer to cut through portions of the sisters' skulls because their older bones were denser than previously believed.

And though the Ladan and Laleh's brains were separate, they had adhered to each other after years of growing and sharing the same skull. That forced doctors to meticulously cut the organs apart, "millimeter by millimeter," Raffles hospital spokesman Dr. Prem Kumar said.

"As the separation was coming to a close, a lot of blood was lost. The twins were subsequently in a critical state," said Kumar.

At one of the final points of the separation procedure, surgeons cut a finger-thick shared vein from Ladan _ leaving her to rely on a similar sized vein taken from her right thigh that was grafted to her brain.

Rerouting the shared vein, which drained blood from their brains, was considered one of the biggest obstacles in the surgery. German doctors told the twins in 1996 that shared vein made surgery too dangerous.

"I am very sad, as all of us are," lead neurosurgeon Dr. Keith Goh said. "Over the last six months, everyone who came in contact with them was touched by their personalities and the kind of people they were."

For more than 50 hours, the team of 28 doctors and about 100 medical assistants worked in tight spaces in front of and behind the twins, who were in a sitting position in a custom-built brace connected to IVs and monitors. Classical music played softly, and surgeons whose expertise was not needed at the moment would slip out of the room for rest.

In the final hours, the surgeons had to contend with unstable pressure levels inside the twins' brains just before they worked to uncouple the sisters' brains and cut through the last bit of skull joining them, Kumar said.

The sisters' brains had "to be teased apart very slowly," Kumar said. "Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues."

Although the sisters knew the operation could kill one or both of them, they decided to face those dangers after a lifetime of living conjoined and compromising on everything from when to wake up to what career to pursue.

"If God wants us to live the rest of our lives as two separate, independent individuals, we will," Ladan said before the operation.

The courage of the twins won them a place in the hearts of Iranians. Television devoted many programs to the twins. Newspapers published page after page about their life and the protracted operation.

Parents of the twins, Dadollah Bijani and Maryam Safari, thanked the Iranian nation for praying for their children, the state-run Tehran radio reported.

"It's a national tragedy," said Ahmad Mahmoudi, a photographer in Tehran.

Housewife Noushin Nowrouzi promptly parked her car after she heard the news on the radio so she could cry in peace.

The sisters were born into a poor family of 11 children in Firouzabad, southern Iran, but grew up in Tehran under doctors' care.

The Iranian government said Monday it would pay the nearly $300,000 cost of the operation and care for the twins.

Participating neurosurgeon Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore, has separated three sets of craniopagus twins.

_____

Editor's Note: Emma Ross, an AP medical writer, contributed to this story from London; AP writer Ali Akbar Dareini contributed from Tehran.

Very sad.

Ted Striker · July 8, 2003, 09:54

That's too bad.

FrustratedPoet · July 8, 2003, 09:55

After cracking their shared skull the surgeons found that their brains had fused together. Needless to say that chopping through their brains caused significant complications.

Shame. They never got to look each other in the eye.

A tragic situation.

rah · July 8, 2003, 10:00

Yes, very sad.

RAH
Thankful I was never attached to my twin.

JohnT · July 8, 2003, 10:11

That sucks.

mrboo123 · July 8, 2003, 10:15

dittio JohnT,

SlowwHand · July 8, 2003, 11:04

Really bad deal. Certainly worth the risk, IMO.
Doctors seemed certain at least one would make it ok, and if the vein was replaced successfully, both.
Had to have been about as tough a life as it gets.

Urban Ranger · July 8, 2003, 11:27

mrmitchell · July 8, 2003, 12:00

Isn't it a little dangerous to do it after 29 years though?

Boris Godunov · July 8, 2003, 12:03

Sad to hear. I was really hoping the doctors could pull it off.

They gave it a go to have a better life, and their bravery was impressive.

Dis · July 9, 2003, 01:00

both are dead?

I had heard one died last night.

brain imaging had shown their brains weren't fused together? I suppose they were wrong. Originally they said the brains were seperate. The tricky part would be that they shared a major artery that supplied both brains.

DinoDoc · July 9, 2003, 01:02

Too bad. I was hoping they would make it.

st_swithin · July 9, 2003, 01:05

Perhaps they both wished to be dead together rather than be alive and alone.

I lost my twin, and now I think about dying all the time.

Kind of funny, huh? ;`(

Dis · July 9, 2003, 01:08

what they wanted was to be normal

that is why they went for such a risky operation

ixnay · July 9, 2003, 01:16

Well, on the plus side, there's 2 less lawyers in the world now.

Drake Tungsten · July 9, 2003, 01:30

Quote:

Well, on the plus side, there's 2 less lawyers in the world now.

DRoseDARs · July 9, 2003, 01:41

I really want to laugh at that, Ixnay. Maybe in a few days...

But for now,

Dis · July 9, 2003, 02:00

Quote:

Originally posted by ixnay
Well, on the plus side, there's 2 less lawyers in the world now.

I don't get it?

I hate it when I don't get jokes.

are these 2 ladies lawyers? That seems highly unlikely for two main reasons. First they are muslim women living in a fairly strict muslim country. second their condition would prevent them from being effective lawyers.

ixnay · July 9, 2003, 03:06

http://www.cnn.com/2003/HEALTH/07/08...ins/index.html

Quote:

The 29-year-old twins -- both law graduates -- had two distinct brains,

http://www.sunspot.net/news/health/b...home-headlines

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Both went to law school because Ladan wanted to, but Laleh has said she wants to be a journalist.

This could make an interesting sitcom, too:

Laleh is a no-holds barred district attorney, out to convict at whatever cost!

Ladan is a world-renowned defense attorney, who always gets her client off!

Watch Motion to Separate, this fall on FOX!

DRoseDARs · July 9, 2003, 03:13

Ok, that one's better...

Skanky Burns · July 9, 2003, 03:30

Its strange. Ix has been posting on the SomethingAwful forums for some time now, but he has not been influenced by their sense of humour yet.

DRoseDARs · July 9, 2003, 04:50

Diss, the first joke was based on a line from Shakespeare's play Henry VI part 2.

And it really isn't unlikely that these two Iranian women were "lawyers." There are plenty of places in the Islamic world were women are not suppressed and denied the same opportunities as men.

I can't recall the author's name (I'll have to dig the book out) but she spent several years travelling throughout the Islamic world to discover what life was REALLY like for women. She found that in many places they enjoy a great deal of what we Westerners think is denied them. Even in Iran, women are given much in a "Seperate but Equal" society. They've fought long and hard to get what they deserve. That's just one short visit she made.

Iran, Sudan*, Egypt, Palestine, Jordan (King Hussein (no relation) and Queen Noor), Saudia Arabia are all places she visited. She describes how she saw both ends of the spectrum in terms of the living conditions for women.

Saudia Arabia sounded a LOT of alarms for her...no suprise there. They've been exporting an extremely intolerant view of Islam that has spread like a disease throughout the Islamic world. That view, and all it entails, would make it difficult for the Bijani sisters to work as lawyers. Palestine used to have one of the most liberal and progressive universities in the Islamic world. That time has since past thanks to Saudia Arabia's exportation of bastardized Islam. In Sudan* women are doing ok, but again SA extends it's tentacles. Egypt, like Palestine, has suffered thanks to SA. Jordan seems to be more distant, but not immune, to the siren song of extremism. The King and Queen have worked very hard to improve their country after "forget the person's government position" had made a mess of things with the people.

Iran seems to be the best place to be a Muslim women. Although USAmericans detest "Seperate but Equal" systems, in Iran it works to great advantage for women. It may very well be the stepping stone towards true modernization and liberty in Islam. Musilm women are showing they really can doing anything the men can do (much to the chagrin of hardliners) and that they are a force to be reckoned with. Women fought alongside the men to overthrow the Shah to install the Ayatollah as leader. And it was the Ayatollah who help set in motion the progress Iranian women enjoy...because it was women who influenced him to help.

If President Jr. is serious about helping moderates in Iran against the hardliners, he'd better not screw up. The liberties women have there now are not certain. The men and women who are fighting without violence to bring liberty to Iran stand to lose everything if Bush isn't careful. Threatening the hardliner government of Iran wasn't a helpful thing to do...

*I can't remember exactly which African nation-not-Egypt she visited, so Sudan will have to do until I find that book.

muxec · July 9, 2003, 05:25

It's better to die than live like they did.

Az · July 9, 2003, 05:45

How the **** didn't they see that their brains were fused on MRI? how didn't they know they were fused by psychology? AFAIk, when brains are fused, people sense each other's feelings. ( spooky, really.)

VJ · July 9, 2003, 06:02

So it goes.

Quote:

I lost my twin, and now I think about dying all the time.

Kind of funny, huh? ;`(

Do you think that it's what your sibling would've hoped for?

Q Classic · July 9, 2003, 08:43

Quote:

Watch Motion to Separate, this fall on FOX

careful, it's just tasteless enough that fox migt do it...

mrmitchell · July 9, 2003, 18:17

I think it will be more of a "When Heartwarming Operations Go Bad" kind of special.

ixnay · July 9, 2003, 18:45

Quote:

Originally posted by Skanky Burns
Its strange. Ix has been posting on the SomethingAwful forums for some time now, but he has not been influenced by their sense of humour yet.

Yeah, after a year you would really think I'd start picking up on that.

Proteus_MST · July 9, 2003, 19:09

So instead of at least one of them living a separate Life, both of them will never see the light of the day.

Truely sad

Provost Harrison · July 9, 2003, 19:25

It was a risky operation and alas it didn't work out...a shame as the world was listening and hoping for a good result, but it wasn't to be...