NAV20
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Girls Joined At The Brain Surgically Separated

Thu Nov 19, 2009 5:48 am

A not-so-minor 'Miracle in Melbourne' to go some way towards off-setting the endless flood of 'doom and gloom' that makes up most of the news nowadays.

In a 31-hour operation, surgeons have been able to separate two little Bangladeshi girls who have been joined at the BRAIN since their birth almost two years ago.

The operation involved first of all separating the blood supplies; then separating the actual brain tissue; then fitting artificial plastic craniums; then rejoining the skin over the operation sites. Part of the reason for the long time it took was that the team had to allow time for the girls' nervous systems to adapt to the enormous changes which surgery on this scale naturally caused.

One of the girls is already awake and talking; the other is taking longer to come round. But neither are showing any signs of brain damage so far.

Warmest congratulations to ALL the people who contributed to this marvellous story. The Bangladeshi orphanage sisters who cared for the girls after their birth, the Australian aid worker who found them and set up the opportunity for surgery, the marvellous lady who fostered them after their arrival in Melbourne, and of course the surgeons and nurses at the Royal Children's Hospital.

Here's hoping for a completely 'happy' ending, with both girls recovering completely and embarking on the 'adventure' of normal life.

http://www.theage.com.au/national/gi...y-over-twins-op-20091118-imko.html
"Once you have flown, you will walk the earth with your eyes turned skywards.." - Leonardo da Vinci
 
san747
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RE: Girls Joined At The Brain Surgically Separated

Thu Nov 19, 2009 7:00 am



Quoting NAV20 (Thread starter):

One of the girls is already awake and talking; the other is taking longer to come round. But neither are showing any signs of brain damage so far.

Amazing what modern medicine can do. Here's to hoping they both live long and happy lives!
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LTU932
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RE: Girls Joined At The Brain Surgically Separated

Thu Nov 19, 2009 7:21 am

I hope that the end result is successful. My best wishes to both girls and my compliments to the doctors for a job well done!
 
CPH-R
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RE: Girls Joined At The Brain Surgically Separated

Thu Nov 19, 2009 7:54 am



Quoting San747 (Reply 1):
Amazing what modern medicine can do.

Indeed!

We've certainly come a long way, since cutting edge surgery meant heating the blade of the amputation saw  Wink
 
NAV20
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RE: Girls Joined At The Brain Surgically Separated

Fri Nov 20, 2009 6:19 am

A few updates today.

"Nov. 20 (Bloomberg) -- A second Bangladeshi twin began waking up today and opened her eyes, three days after being separated from her conjoined sister by surgeons in Australia.

"Krishna is “waking up slowly,” the Royal Children’s Hospital in Melbourne said in a statement. “She is more alert, starting to breathe more and opening her eyes.”

"Her sister, Trishna, regarded by doctors as the stronger of the twins, woke yesterday and was talking and behaving normally. Both girls are in a “serious but stable condition.”


http://www.bloomberg.com/apps/news?pid=20601081&sid=aww5NktbJPO4

Apparently Krishna was much more dependent on her sister than Trishna was on her. Among other things, her kidneys only began functioning on their own during the operation; and, from this latest story, it seems as if even her breathing was 'at secondhand.'

Fingers crossed that she too 'makes it' - and they both recover 100%.
"Once you have flown, you will walk the earth with your eyes turned skywards.." - Leonardo da Vinci
 
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DocLightning
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RE: Girls Joined At The Brain Surgically Separated

Fri Nov 20, 2009 10:40 pm



Quoting NAV20 (Thread starter):
and of course the surgeons and nurses at the Royal Children's Hospital.

Especially the surgeon. It's one thing to do a procedure you've done before and know how to do with your eyes closed, but I assure you, the surgeon had never seen or done anything like this.

Takes a special kind of fortitude to do something like that when you know full well that you don't know what you're doing because nobody's done it before.

Kudos to you, doctor. Sleep well tonight.
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Aaron747
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RE: Girls Joined At The Brain Surgically Separated

Fri Nov 20, 2009 10:52 pm



Quoting DocLightning (Reply 5):
Takes a special kind of fortitude to do something like that when you know full well that you don't know what you're doing because nobody's done it before.

Surely though the surgical team doesn't go about things willy nilly. Don't they always have a plan of attack and certain contingencies to prepare for? There may be nothing in the literature about doing this kind of thing but it strikes me as fairly obvious that disconnecting or reconnecting the arteries feeding the brain and pacing everything to restore/promote autonomic functions would be the primary concerns in the procedure.

It's just amazing to me that these people wake up, drive to the hospital, scrub in, and go to work on something like this for hours and hours without fail. How do they build such endurance and mental focus??
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DocLightning
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RE: Girls Joined At The Brain Surgically Separated

Sat Nov 21, 2009 12:29 am



Quoting Aaron747 (Reply 6):

Surely though the surgical team doesn't go about things willy nilly. Don't they always have a plan of attack and certain contingencies to prepare for?

They'd try to gather as much information as possible. Certainly a 3-D MRI angiography to visualize brain tissue and vascular anatomy. Probably an 3-D reconstructed CT scan to visualize bony anatomy. Ultrasounds with doppler to evaluate blood flow through various blood vessels (in a case like this, blood in an artery is always moving away from the heart...but which heart?).

There would be a surgical rounds with the orthopedic surgeons, neurosurgeons, vascular surgeons, anesthesiologists, and any other involved specialties and they would examine the information that they have and develop an approach.

The fact remains that, in spite of all this preparation, this is the human body and it has a penchant for throwing curve balls. We don't fully understand it, in spite of all we know. And, on top of that, given the abnormal anatomy and development, questions about differential renal function, etc., there are a lot more unknowns than knowns.

However, the alternative is to do nothing. And that is worse than trying and failing. I think the parents understood that the risk was that they might lose one or both kids, but that if they did nothing, the consequences might be worse than death.

Quoting Aaron747 (Reply 6):

It's just amazing to me that these people wake up, drive to the hospital, scrub in, and go to work on something like this for hours and hours without fail. How do they build such endurance and mental focus??

It amazes me, too. I simply wasn't cut out for it (not that I was particularly interested in being a surgeon, anyway). A surgeon needs to be the kind of person who can focus on a task until the task is done correctly. Doesn't matter that the case is going longer than planned and you will have to miss your 6PM dinner plans: a life is one the line. And, even more amazingly, they do it standing up. A lot of it is sheer terror. If you screw up, the baby dies and it's on you.

I think a lot of surgeons go into a bizarre trance-like state in the OR where there is the surgical field (the part you're operating on), the other people who are scrubbed in, and the circulating nurse. They completely forget about the patient other than the surgical field. You have to, because if you stop and start thinking that you're cutting into a person, it's pretty overwhelming. I made that mistake once and almost passed out. Like I said, I did my two required months of surgery in medical school and vowed that I would never scrub in another case as long as I live. Just isn't for me.

Similarly, I don't understand how a pilot can stay focused on the instruments while piloting a plane on a 7-hour flight with long stretches of nothing to do. I'd go bananas.
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NAV20
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RE: Girls Joined At The Brain Surgically Separated

Sat Nov 21, 2009 6:16 am

Krishna has apparently woken up and performed her favourite party trick - blowing a raspberry at her guardian!  

http://www.theage.com.au/national/tw...llyinduced-coma-20091121-is1q.html

There's a long way to go before the medical team can be certain that the op was completely successful - but, as Churchill once said in a different context, this is possibly 'the end of the beginning.'

Quoting DocLightning (Reply 5):
Kudos to you, doctor. Sleep well tonight.



Quoting Aaron747 (Reply 6):
How do they build such endurance and mental focus??

Couldn't agree more, Doc, Aaron. A fantastic team effort. If you view the 'unbelievable success' video on the left, you'll see a very ably-conducted press conference given by the Head of Neurosurgery at RCH, Dr. Wirginia Maixner, which gives some idea as to the pressures they were under.

Looking at your remarks on what it takes to be a surgeon, Doc, if (now the pressure's off) I'm allowed a joke; maybe, with a name spelt like that, she HAD to opt for surgery because her spelling wasn't good enough to write prescriptions!

[Edited 2009-11-20 22:33:48]
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DocLightning
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RE: Girls Joined At The Brain Surgically Separated

Sun Nov 22, 2009 1:56 am

If she's anything like me, the first thing she will do when she sleeps is go into a deep sleep about the OR. After intense days like that, work tends to come home with you.
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NAV20
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RE: Girls Joined At The Brain Surgically Separated

Tue Nov 24, 2009 5:30 am

As the lead neurosurgeons, Dr. Maixner and her colleague Dr. Alison Witt can be extremely proud of their achievement.

Both twins have now been moved out of intensive care and put in adjoining beds in a normal ward. No sign of brain damage or loss of any faculties in either so far, but they are naturally still very tired and under partial sedation.

It would be absolutely fascinating to see them 'getting used to' being separated. Apparently they had literally never seen each other's faces before this, except by use of mirrors. Nor, of course, have they ever learned to stand or walk.

http://www.bloomberg.com/apps/news?pid=20601091&sid=aeUsOF3y6UlY
"Once you have flown, you will walk the earth with your eyes turned skywards.." - Leonardo da Vinci
 
NAV20
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RE: Girls Joined At The Brain Surgically Separated

Tue Nov 24, 2009 1:14 pm

Still more marvels - according to our radio news, the weaker twin has begun eating the first food she's ever had in her life. Previously the stronger twin had done the eating for both of them.........
"Once you have flown, you will walk the earth with your eyes turned skywards.." - Leonardo da Vinci
 
Stealthz
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RE: Girls Joined At The Brain Surgically Separated

Tue Nov 24, 2009 1:28 pm

A truly amazing story and as Doc said "especially the surgeon".. I think in this case it was 8 of them!
A project if that is the right word 2 years in the planning and apparently brilliantly executed.

If I may follow Nav's lead and add a moment of lightness that in a way supports Doc's comments on surgeons...

A leading surgeon went to pick up his exotic supercar after some major workshop time. While explaining the parts that were replaced, the plumbing repaired and the software upgrades to the engine management system, the mechanic commented that their jobs were in some way similar so it didn't seem fair he made $35,000 a year and the surgeon close to a $1,000,000..... the surgeon replied... Try doing it with the engine running!

These heroes not only did it with the engine running (x2) but all the pieces were tangled together!

Great job!
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DocLightning
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RE: Girls Joined At The Brain Surgically Separated

Tue Nov 24, 2009 10:29 pm



Quoting StealthZ (Reply 12):

A leading surgeon went to pick up his exotic supercar after some major workshop time. While explaining the parts that were replaced, the plumbing repaired and the software upgrades to the engine management system, the mechanic commented that their jobs were in some way similar so it didn't seem fair he made $35,000 a year and the surgeon close to a $1,000,000..... the surgeon replied... Try doing it with the engine running!

I have another one. A neurosurgeon has a huge leak in his basement. After futzing around downstairs for 30 minutes, the water is going past his ankles and his wife says that she's calling the plumber.

The plumber comes over, goes downstairs, and comes back a half hour later. The downstairs is clean and dry and the leak is fixed. He hands the surgeon a bill for $3000. The surgeon says "I'm a neurosurgeon and I can't charge this much for 30 minutes of work!"

The plumber casually says: "Yeah. I used to be."  rotfl 
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