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Kathmandu Wednesday April 11, 2001 Chaitra 29, 2057.
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Ganga, Jamuna separated successfully
Doctors optimistic after rare surgery
By Dean Visser
SINGAPORE, April 10 (AP) - Eleven-month-old twins Jamuna and Ganga Shrestha
were in different rooms for the first time in their lives Tuesday after doctors
successfully separated the girls, who were born joined at the head.
A wide-eyed Jamuna _ the more bashful sister _ was wheeled out of the
operating room wearing a tiny surgical cap early Tuesday after a rare, grueling marathon
surgery doctors are calling a success.
The feistier sister, Ganga, finally left the Singapore General Hospital
operating room at 4 p.m. _ 96 hours after entering it. Dr. Keith Goh, who led the medical
team, said Ganga’s operation took longer because she needed more "complex
reconstruction."
Goh said it was too early to tell if the twins would suffer brain damage or
other neurological defects, and that the next few days would be crucial for the baby
girls.
"Happily, we had no adverse events throughout the entire five days"
of surgery, Goh told reporters at a news conference after the surgery. "We are
cautiously optimistic."
The Nepalese twins were joined at the tops of their heads and shared the same
skull cavity. Their brains were partially fused, making the separation surgery extremely
difficult.
Surgeons initially hoped to finish the operation within 40 hours. Twenty
doctors worked in shifts around the clock to separate the girls. Anesthesiologist Claire
Ang said the mood in the operating room "varied from euphoric to hysterical."
To close the wound left by the surgery, doctors used the synthetic material
Gortex to replace parts of the girls’ dura, a fibrous tissue layer covering the
brain. They mixed bone material with polymer to help rebuild the girls’ tiny skulls.
Goh and other members of the medical team said the surgery took so long
because they had to deal with hundreds of interwoven blood vessels in the girls’
brains.
Before the surgery, doctors rehearsed the procedure in virtual reality using
a three-dimensional imaging system developed in Singapore.
The system, called VizDExter, was first used in 1998 by doctors at John
Hopkins University in Baltimore, Maryland, said Dr. Luis Serra, a Singapore-based
researcher who helped develop the technology.
Serra told The Associated Press on Tuesday that the Singapore doctors used
the 3-D images to consult with a Johns Hopkins’ Siamese twins expert, Dr. Benjamin
Carson, before separating Ganga and Jamuna.
Siamese twins joined at the head are very rare, occurring once in 2 million
live births, according to Goh. Successful separations are even more uncommon.
Surgeons in Brisbane, Australia, last year successfully separated
six-month-old Tay-lah and Monique Armstrong, who were joined at the backs of their heads.
A similar operation was successfully performed in South Africa in 1997.
Ganga and Jamuna, the twins in the Singapore surgery, are the only children
of the couple from the remote Nepalese mountain village of Khalanga in Salyan district.
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