SINGAPORE July 8—
Neurosurgeons separated 29-year-old Iranian twins joined at the head Tuesday after two days of delicate surgery, but both sisters died shortly after their parting.
The hospital announced Ladan Bijani's death, then, a few hours later, a nurse involved in the surgery said her sister Lelah had died.
"Everyone upstairs is crying," said the nurse, speaking on condition of anonymity. "We treated them like family because they had been here for seven months."
Hospital officials have yet to officially announce the second death.
Earlier, doctors said Ladan died after they were unable to stabilize her condition.
"As the separation was coming to a close, a lot of blood was lost. The twins were subsequently in a critical state," said Raffles hospital spokesman Dr. Prem Kumar.
The risky, marathon separation procedure began about 10 p.m. EDT Saturday. Before the operation, doctors had warned that the surgery could kill one or both of the twins, or leave them brain-dead.
The brains of Ladan and Laleh Bijani were separate, but were nonetheless stuck together after years lying alongside each other.
Kumar had warned that controlling the bleeding and moving the twins from a seated position onto separate beds would be the biggest challenge, and that the condition of either twin would remain largely unknown until they wake up after surgery. The twins were seated during the operation.
As one of the final points of the separation procedure, surgeons cut a finger-thick shared vein from Ladan leaving her to rely on a similar sized vein taken from her right thigh that was grafter to her brain.
Rerouting the finger-thick shared vein, which drained blood to their hearts, was considered one of the biggest obstacles in the surgery. German doctors told the twins in 1996 that shared vein made surgery too dangerous.
The team of doctors had to contend with unstable pressure levels inside the twins' brains just before they worked to uncouple the sisters' brains and cut through the last bit of skull joining them, Kumar said.
The sisters' brains had "to be teased apart very slowly," Kumar said. "Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues."
He said surgeon worked "millimeter by millimeter."
The operation was complicated further when the team discovered that the pressure in the twins' brains and circulatory system was fluctuating.
Dr. Marc Mayberg, chairman of neurosurgery at the Cleveland Clinic in Ohio, had said by telephone the pressure fluctuations could be fatal.
Although the sisters knew the operation could kill one or both of them, they decided to face those dangers after a lifetime of living conjoined and compromising on everything from when to wake up to what career to pursue.
"If God wants us to live the rest of our lives as two separate, independent individuals, we will," Ladan said before the operation.
An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The Iranian government said Monday it would pay the nearly $300,000 cost of the operation and care for the twins.
This is the first time surgeons have tried to separate adult craniopagus twins siblings born joined at the head. The surgery has been performed successfully since 1952 on infants, whose brains can more easily recover.
Participating neurosurgeon Dr. Benjamin Carson, director of pediatric neurosurgery at Johns Hopkins Children's Center in Baltimore, has separated three sets of craniopagus twins.
Because this operation is a medical first, surgeons have encountered unexpected obstacles not seen in infants. It took longer to cut through portions of their skulls because their older bones were denser than previously believed, Kumar said.
As the procedure dragged on, surgeons tried to get adequate rest, slipping out of the operating room for breaks when their expertise was not needed, Kumar said.
Classical music played softly as surgeons worked simultaneously in tight spaces in front of and behind the twins, who sat in a custom-built brace connected to an array of lines feeding them intravenously and monitoring their vital signs, Kumar said.