One Twin Dead After Separation
Tuesday, July 8, 2003 Posted: 4:18 AM EDT (0818 GMT)
One of the conjoined adult Iranian twins separated after unprecedented surgery has died, according to officials at Singapore’s Raffles Hospital.
Ladan Bijani, the more outspoken of the two, died due to a severe loss of blood as the separation of the twins’ brains was coming to a close. Doctors are working to stabilize her sister Laleh, who is still critical from the risky operation. Neither twin was believed to be at a greater risk ahead of surgery. There were tears at the hospital in Singapore as spokesman Dr. Prem Kumar Nair made the announcement. The twins made a big impression around the world with their display of courage and bravery going into the dangerous operation. Doctors at one point tried to talk the them out of the operation, but the 29-year-old sisters, both law graduates, said they were willing to accept the risks and face those dangers to lead separate lives.
Earlier Tuesday, neurosurgeons carefully teased apart packed brain tissue millimeter by millimeter in a delicate and risky procedure on the third day of the operation. Surgery to separate the twins, who were joined only at the head, began on Sunday and doctors had to battle against unstable blood pressure levels as they slowly split apart the fused brains. The complicated process of paring apart the twins’ brains began late Monday and separating them was one of the most challenging parts of the surgery, dubbed “Operation Hope.”
Prior to separating the brains, surgeons completed the process of rerouting a large vein that serves both their brains.
An international team of neurosurgeons, dozens of doctors, plus support staff created a bypass for Ladan, using a vein grafted from her leg. This caused another complication, Kumar said, as blood circulation between the twins became unstable.

More hurdles ahead
The operation is a landmark procedure. Although Singapore doctors performed a similar operation in 2001 on infant Nepalese girls, surgery on adult twins is unprecedented.
The operation is more difficult in adults than in children, who have more recuperative powers. Twins joined at the head are the rarest of conjoined twins, occurring one in every 2 million births. Twins joined elsewhere occur once in every 100,000 births.
The Bijanis’ operation was considered elective because the women likely would live a normal life span without it.
However, testing showed the sisters had high intracranial pressure, which, if untreated, could cause frequent debilitating migraines and impaired vision as well as deteriorating brain function, the hospital said. The sisters made an impression on Singapore’s public, in part because of their cheerful demeanor before the operation. Cards, flowers, and offers of support were sent to the hospital from around the world.
The hospital paid for pre-operative fees and the medical costs involved in operation. The operating surgeons waived their professional fees. The government of Iran said Monday it will pay $300,000 for post-operative care.
Source: CNN.com

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