Doctor: Separated twins ‘right on target, if not ahead of schedule’
The twins who were joined at the head and underwent a 27-hour surgery last month to separate them are progressing “right on target, if not ahead of schedule,” the lead neurosurgeon tells CNN.
“As a neurosurgeon, I guess it puts you in a happy mood,” said Dr. James Goodrich, who led the operation at the Children’s Hospital at Montefiore Medical Center in the Bronx, New York.
The surgery on the 13-month old twins, Jadon and Anias McDonald, captivated millions around the world. The procedure, known as craniopagus surgery, is so rare that it has been conducted only 59 times since 1952.
CNN was allowed exclusive access to the surgery and the McDonald family. Christian and Nicole McDonald have been buoyed by the outpouring of support from around the world and have asked for space as their family heals.
Both boys have had their breathing tubes removed since the operation, which began the morning of October 13 and ended shortly before 1 p.m. October 14. Jadon had suffered partial paralysis of his left side after the surgery, but he has since regained full functionality.
Anias suffered seizures postoperatively, but they have been kept in check with medication.
“I don’t think that is going to be a long-term issue with him,” Goodrich said.
Nicole held Jadon for the first time in late October, a moment she had dreamed of since before the twins were born.
The twins are doing so well, Goodrich says, he hopes that in coming weeks, “we’ll have them both out of here, off to rehab.”
Added Dr. Oren Tepper, the lead plastic surgeon charged with reconstructing the boys’ skulls, “All in all, I think they’ve handled the surgery incredibly well. … They’ve been entirely stable in the ICU since the operating room, and I think that, in and of itself, is a real success.”
Jadon and Anias’ craniopagus surgery was the seventh performed by Goodrich. He and Tepper headed up a team of more than 30 people at Montefiore, from anesthesiologists and radiologists to nurse practitioners.
Here, for the first time, the surgical team describes in their own words the key moments inside the operating room and what it was like to be a part of such a rare surgery. The quotes have been edited for length and clarity.
‘We would’ve lost one or both children’
Goodrich said the “most unexpected surprise” came hours into the surgery, when the team learned that the boys’ brains were fused more than they realized.
When the boys first arrived at the hospital months ago, the twins shared about 1.5 centimeters in diameter of brain tissue, but as they grew during their stay, so did the fused tissue.
Going into the surgery, doctors believed the twins had about 3.8 centimeters in diameter of fused brain. Once they operated, they found that it was even larger.
“When we actually got in there, their brains were totally fused. It was a bigger fusion than we expected in the sense it was about 5 centimeters by 7 centimeters. For a child that size, that’s a good chunk of tissue, but we had to separate them, and so to do that, it was a matter of just picking a plane between the two.
Intraop, we’d done some beautiful imaging studies of the venous anatomy, but as has always been the case, when you get down in there, it’s even more complex than you realized when you started.
“There was a very large venous complex that had a huge potential of bleeding, and if we lost control of that, we would’ve lost one or both children. I took in extra time, and we added another four hours onto the case to get the exposure, and we eventually found a nice window, which just kind of opened up, and we followed it down.
“The problem with these, these veins are abnormal. They’re very thin, and if they rupture, you have no way of controlling them. It’s a situation where you have to have total control all the way through, because once you lose it, you can’t back off. I was at a point that I was wondering whether we were going to lose both kids if one of those things broke. Then again, after discussion with various members of the team, we picked an avenue that was safe — and it worked.
“I’m just glad it wasn’t my first craniopagus surgery. That would’ve been ominous. This is now our seventh set that we’ve separated. Every one of them had their own unique idiosyncracies.
These kids, in the sense of the vascularity, I actually thought they were going to be simpler. Simpler is not the right word, but less complex than what we’d done before. But in actual fact, they turned out to be as equally complex as any of them. They were a challenge.”
Pediatric neurosurgery nurse practitioner Kamilah Dowling stayed in touch with the parents throughout the surgery, updating them about every two to three hours. “I would text Nicole or give her a call.
First, I would check with Dr. Goodrich to see where are we now, what are we doing, and this is what I am going to tell Nicole. If we were having blood pressure issues, anything that was going on at that moment, I would share with Nicole. I feel that we did our job as nurse practitioners. We supported the family from beginning to end. We’ll continue to support them emotionally, anything they need.”