U.S. doctors divide conjoined twins' blood flow, surgery date pending

Doctors succeeded in giving independent blood flow to 3-year-old conjoined twins as they prepare for a high-risk procedure to separate them, a doctor said Friday.

Tatiana and Anastasia Dogaru underwent another procedure Thursday in which a second coiled wire device was inserted into veins in their brains, which share tissue. The top of Tatiana's head is attached to the back of Anastasia's.

Dr. Alan Cohen, who is chief of pediatric neurosurgery at Rainbow Babies & Children's Hospital, said it was a planned follow up to a similar procedure April 26.

The two procedures were designed to divert blood flow which had been shared in the brains of the two girls so that almost all blood flow from each of their bodies would go only to their own brains.

Cohen said it was a necessary step before their separation.

A team of up to 50 doctors and nurses will separate the girls in four stages over several weeks. They have not yet determined a date for the beginning of the separation.

"We have to coordinate everything. We meet weekly to try to decide this, but we don't have a date at this point," Cohen said. "Right now, we're just pleased to say that everything is going nicely."

The girls remained at the hospital Friday following the procedure. Cohen is hopeful they can go home Saturday.

"Tatiana's blood pressure, which was elevated before this, has come down, and Anastasia's blood pressure, which was low, has come up. So we're seeing effects of separating the circulation already," Cohen said.

The twins, born in Rome, arrived in Cleveland on April 6 after 2 1/2 years in Dallas. Their parents are from Romania. Without separation the twins run the risk of dying in early childhood.

Twins born joined at the head _ called craniopagus twins _ are extremely rare, occurring in about one in 2.5 million births.

Before the brain separation begins, doctors will have to estimate the size of the skull openings that will be necessary and design skin and bone flaps that will be used to close those openings, said Cohen and Dr. Arun Gossain, a pediatric plastic surgeon at Rainbow who is part of the surgery team.

Doctors are using life-sized models of the conjoined brains and will make skull models to practice and determine in advance the size of any openings.

"Over the next two to three weeks, we will be planning the design of the surgery," Gossain said. Team doctors will be asked at each stage to verify that continuing is proper or to call for a delay if concerns arise, he said.