3-year-old twins joined at the head arrive in Cleveland to prepare for separation

Two 3-year-old girls joined at the head arrived Monday in a private jet from Dallas, a prelude to weeks of medical tests and possibly months of surgical procedures.

Anastasia and Tatiana Dogaru, who were born in Italy but are of Romanian descent, were brought to the United States with their parents at 9 months to be evaluated for separation surgery.

A team of doctors seek to separate the twins in four stages over several weeks at Rainbow Babies & Children's Hospital, part of University Hospitals of Cleveland. Anastasia, the larger twin, also requires a kidney transplant; she relies on Tatiana's kidneys.

The medical team is "approaching the treatment of Anastasia and Tatiana with hope and optimism, and also with a need to temper our expectations with realism," Dr. Nathan Levitan, chief medical officer for University Hospitals, Case Medical Center, said at a recent briefing.

For the past 2 1/2 years, Anastasia and Tatiana have been in Dallas. The World Craniofacial Foundation brought them to this country to be evaluated.

The top of Tatiana's head is attached to the back of Anastasia's. Twins born joined at the head are extremely rare, occurring in about 1 in 2.5 million births.

Among the surgical risks are the possibility of brain damage, stroke or fatal blood loss.

Doctors say it appears the girls share only a small portion of brain matter. Before their final separation, they will have skin expanders placed in their heads to make sure there is sufficient cover once they are separated.

The Dogaru family sought out the foundation after hearing about a successful conjoined-twin separation in 2003 at Children's Medical Center in Dallas.

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On the Net:

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

Rainbow Babies & Children's Hospital: http://www.rainbowbabies.org