Twin Boys Stable As Separation Continues

The biggest challenge facing pediatric neurosurgeons dividing 2-year-old Egyptian twins joined at the head is separating the intricate connection of blood vessels in their brains.

Doctors have spent more than a year planning the surgery to separate Ahmed and Mohamed Ibrahim. The operation is expected to take a team of 50 to 60 medical personnel anywhere from 18 to 90 hours to finish. As of late Saturday, the twins were listed in stable condition and the operation was continuing, the hospital said.

“This is the part of the procedure that carries the most inherent risks,” Dr. Jim Thomas, chief of critical care medicine at Children’s Medical Center Dallas, said Saturday, the first day of the complicated separation surgery.

“This is where they’re going to get into the vascular division,” Thomas said. “This is where they’re going to begin to expose the blood vessels by removing the bony plate and to begin the process of dividing the venous system that joins Ahmed and Mohamed.”

Relatives of the boys in the tiny village of el-Homr, near the southern Egyptian city of Qus, prayed for their safe return. Their parents were in Dallas for the surgery.

The first step was to remove skin expanders inserted in the boys’ heads about five months ago. The extra skin and tissue created by the expanders will cover the head wounds.

Much of Saturday morning was spent positioning the boys in a specially made bed that lets doctors swivel their bodies for easy access to the front and back of their heads, Thomas said.

While each boy has his own brain, they share an extensive attachment of blood vessels, which neurosurgeons must separate.

“It is all in God’s hands now,” an uncle of the twins, Nasser Mohammed Ibrahim, said in a telephone interview. “He is the one who can save their lives.”

The boys were born June 2, 2001, by Caesarean section to Sabah Abu el-Wafa and her husband, Ibrahim Mohammed Ibrahim.

Dallas-based World Craniofacial Foundation, a nonprofit group that helps children with deformities of the head and face, arranged to bring the boys to Dallas in June 2002 for an evaluation.

A team of specialists determined the boys could be separated, though the risks include possible brain damage and death. The boys’ father told doctors he felt it was worth it to give them a chance at a normal life.

The father spent much of the past year in Dallas with the boys before returning to Egypt this summer. He returned this week with his wife and the twins’ young brother, Mahmoud.

Thomas said the parents were “doing fine.”

“I think the parents are helped in many ways by a very strong faith structure that they have,” he said.

“They have said repeatedly to all the parties involved that this is in God’s hands.”

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On the Net:

World Craniofacial Foundation: http://www.worldcf.org

Children’s Medical Center: http://www.childrens.com