After more than 22 hours of surgery, members of the anesthesiology team, led by Barbara Van De Wiele (left) prepare one of the Guatemalan twins for transport on Aug. 6 to the Pediatric Intensive Care Unit of the Mattel Children’s Hospital. As of presstime Aug. 8, the girls were listed in critical but stable condition.
UCLA Today Staff
All their young lives, conjoined twins Maria Teresa and Maria de Jesus were only able to see each other with mirrors. When they regain consciousness this week after undergoing more than 22 hours of separation surgery, they will be able to see each other as individuals for the first time.
The realization of what the precise medical teamwork at the UCLA Medical Center had achieved came some 12 hours into the surgery. “You are looking at two children, two little girls,” said lead neurosurgeon Jorge Lazareff. “There will be two passports, two boyfriends, two weddings.”
As of presstime last week, the 1-year-old twins from Guatemala remained in critical but stable condition in the Pediatric Intensive Care Unit (PICU) of UCLA’s Mattel Children’s Hospital, where surgery began Aug. 5.
Two days following the surgery, the smaller twin, Maria de Jesus, briefly fluttered her eyes after doctors took the twins off muscle relaxants, which were given to prevent movement that could cause brain injury.
As the world watched through the camera lenses of a throng of international media holding vigil outside the hospital, doctors said that they were “cautiously optimistic” about the long-term prospects of Las Maritas (the little Marias, as they are dubbed in Guatemala) and believe that by early this week the twins will be conscious and removed from ventilators.
“This surgery doesn’t end until the twins open their eyes and are smiling back at us,” Lazareff said.
Andy Madikians, attending physician for the twins in the PICU, said, “There are still many medical hurdles to cross.” In fact, just a few hours after leaving the OR, Maria Teresa was rushed back and underwent a five-hour procedure to correct a subdural hematoma, or pooling of blood in the brain. In the future, the girls will also need other reconstructive surgeries.
In all, more than 50 doctors, nurses and medical staff of the UCLA Medical Center — many who are donating their services — are involved in the twins’ care. The surgical team was led by Lazareff, director of pediatric neurosurgery, and Henry Kawamoto Jr., surgical director of the UCLA Craniofacial Clinic.
The girls’ father, Wenceslao Quiej López, 21, who saw his daughters after the surgery, said, “The future looks very bright,” and thanked the medical team for their efforts. The twins and their mother, Alba Leticia Álvarez, 23, were flown from Guatemala to UCLA after the charity, Healing the Children, approached Lazareff, one of their volunteer physicians.
Because the girls were connected at the back of the head at a 120-degree angle, Lazareff said they would never be able to walk or stand.
While initial tests showed that the babies had two distinct brains, the girls shared some venous drainage, but doctors could not know the extent until they took a look inside.
Making the first incision at 1:49 p.m., Kawamoto and plastic surgeons cut the scalp so that the flaps would fold back to cover each child’s brain. Next, the neurosurgical team began removing a rim of skull that allowed doctors to see the dura, the fibrous membrane that envelops the brain. Neurosurgeons then began opening the brain, painstakingly identifying, cutting and rerouting the veins to avoid the possibility of stroke. Then surgeons began working on the bottom side of the head, crouching underneath the operating tables to remove the remaining portion of the dura and bone.
Finally, almost 12 hours after surgery began, a doctor announced, “They are separated.” But no one had time to celebrate. The surgery was only about two-thirds complete. With the cutting of the last flap of skin, the process of reconstruction began.
“We took the remaining scalp and put it through a special process stage by making cuts into the skin so you could open it up like a net stocking,” Kawamoto explained. “In this way, we were able to triple the amount of material.”
At 5:40 a.m., the girls were wheeled into the PICU, where a new team took over.
“This is a whole new life for these kids,” said neurosurgeon John Frazee, who led the team in rerouting the veins. “I’d like to see them five years down the line and know what they are like and what they are doing.”
The medical center has created a fund to help underwrite the $1.5-million cost of their care. To find out how you can donate and to see updates on the girls’ condition, go to http://healthcare.ucla.edu/conjoined_twins/index.asp.