June 12, 2003

Staci Vernick Goldberg Jessica Collins
PHONE: 410-516-4958 PHONE: 410-516-4570
E-MAIL: svernick@jhmi.edu E-MAIL: jcolli31@jhmi.edu

Pediatric Neurosurgeon Benjamin Carson, M.D. To Separate Adult Conjoined Twins in Singapore

Please Note: A medical illustration of the twins is available. See links at the bottom of this page.

Benjamin Carson, M.D., the director of pediatric neurosurgery at the Johns Hopkins Children's Center who has surgically separated three sets of conjoined twins, will join an international effort, to separate 29-year-old female twins who are conjoined at the head.

The surgery, believed to be the first for adult craniopagus twins, is scheduled to take place at the Raffles Hospital in Singapore during the first week of July, and to last at least 24 hours.

Although their skulls are fused side by side, the twins, Iranian law school graduates Laleh and Ladan Bijani, have distinct brains, making surgical separation possible. Because they share significant vascular structures, including the sagittal sinus, the major blood drainage system of the brain, the surgical team will need to re-route blood flow within both brains, possibly by grafting blood vessels taken from other parts of their bodies.

Carson, whose experience includes the first separations of twins joined at the back of the head and of twins joined at the tops of the head, will lend his expertise to the Singapore team in a consulting role. The team, still being convened, will be led by Keith Goh, M.D., consultant neurosurgeon at Raffles Hospital; and Walter Tan, M.D., medical director of Raffles Hospital and a consulting plastic surgeon.

"The women have expressed a very strong desire to be separated and live independent lives," said Carson. "Their anatomy permits separation by an experienced team. These facts, together with their strong feelings, tell me that it's appropriate to move forward with the surgery.

"We will remain flexible as we approach the surgery, recognizing that there will be twists and turns along the way, and relying on our experience to guide our surgical plan."

In general, the risks during and after separation include anesthesia and surgical complications. During surgery, both twins receive anesthesia using two separate sets of equipment. Surgical complications can include formation of blood clots in the newly constructed blood vessels, intracranial bleeding, heart complications and infection. The critical period is three to four days after surgery. Carson says the age of the twins presents additional risks, both because their adult brains have lost a great deal of the plasticity that may be needed to reorganize functional areas and because the psychological impact is likely to be greater than in children.

"In this case of separating adult conjoined twins, there are psychological issues that will have a significant effect on both, even after a successful separation," said Carson. "These twins have had a lifelong psychological dependence on one another."

The women will continue to undergo psychological counseling after surgery to manage the emotional effects of separation, and will likely remain hospitalized at Raffles under close observation for weeks or months. They will later receive outpatient, post-operative care in Iran. In the future, they may require cranial reconstructive surgery, cosmetic surgery, physical therapy, occupational therapy and speech therapy.

Conjoined twins occur once in every 70,000 to 100,000 live births. Craniopagal conjoining is among the rarest form of conjoined twins, occurring approximately once in every 2 million live births.

Johns Hopkins Children's Center surgeons have separated five sets of conjoined twins since 1982. Most recently, in 1997, Carson traveled to South Africa and led a 50-member medical team in the successful separation of 11-month-old Zambian craniopagus twin boys. Carson credits the success to "surgical rehearsals" with a computerized, 3-D virtual toolbox that allowed him to "see" computerized reconstructions of the twins' brains. Similar technology will likely be used in the case of the Bijani twins.

Audio of Press Briefing

View image (JPEG file): Medical illustration based on radiologic imaging studies of craniopagus twins, Laleh and Ladan Bijani.

Download the high resolution TIF file of this image (Size: 4.36 MB).
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View our fact sheet on conjoined twins.

View the bio of Ben Carson, M.D.

For more information on the surgery, the Raffles medical team, or the Bijani twins, contact Liang Hwee Ting at (65) 6311 1312 or liang_hweeting@rafflesmedical.com