August 2 2002

Conjoined Twins Celebrate First Birthday at UCLA’s Mattel Children’s Hospital

Doctors Set Date for Separation Surgery

Conjoined twins Maria Teresa and Maria de Jesus Quiej-Alvarez celebrated their first birthday July 25, 2002 at a party with their mother, local relatives, medical staff and Healing the Children volunteers at UCLA’s Mattel Children’s Hospital. The children are doing very well – they are thriving, playing and even trying to crawl.

The Quiej-Alvarez twins, Maria Teresa and Maria de Jesus with their mother Alba Leticia Alvarez.

The twin girls, who are joined at the head, will reach another milestone next week. The doctors have set the date for their separation surgery for Monday, August 5. The surgery is expected to last approximately 10 hours and will involve more than 50 medical staff, including neurosurgeons, plastic and reconstructive surgeons, anesthesiologists, and nursing support staff.

“Based on our diagnostic test findings and multiple planning meetings with all of the specialties involved, we feel confident that our team is ready to proceed with the separation,” said Dr. Jorge Lazareff, associate professor of neurosurgery. “However, the surgery itself is only the first phase in helping the twins. We feel this process won’t be complete until both girls leave the hospital with the same happy smiles that they have now.”

Since the twins’ arrival at UCLA on June 7, they have undergone a series of diagnostic tests, including a magnetic resonance imaging (MRI), an angiogram, a computed tomography angiogram (CTA) and developmental testing.

Results showed the twins’ brains appear separated by a membrane and look normal in size and structure. However, tests also showed that while each child possesses normal arteries feeding the brain, a portion of the veins draining the brain return to the other twin. If doctors can’t preserve and reroute those veins normally, both twins may be at risk for stroke.

Once the doctors separate the twins, they face the challenge of covering the skull defect. On June 24, doctors surgically implanted two balloons under the babies’ scalp. Since then, they’ve been injecting one of the balloons with saline, causing the tissue to stretch. Now, doctors say the skin has stretched enough to provide adequate coverage once they are separated. The second balloon implant - where the thin skin tore during the procedure - was never used.

Surgeons who will be performing the operation are Dr. Henry Kawamoto Jr., surgical director of the UCLA Craniofacial Clinic (left) and Dr. Jorge Lazareff, associate professor of neurosurgery.

Doctors also have been studying three-dimensional physical models that replicate the twins’ heads’ blood vessels, juncture and structural defects and show their veins, skull and bones. The life-size models, valued at $10,000, were designed and donated by Bio-Medical Modeling of Boston, Mass. UCLA surgeons have studied the models, which are made of plastic grown from a liquid medium, to rehearse for surgery and to help them determine where to cut the bone and tissue and reshape the skull.

“We hesitate to say we have one exact plan going into surgery,” said Dr. Henry Kawamoto Jr., surgical director of the UCLA Craniofacial Clinic. “Once we go in, we may find that we need to alter our original plan and do something differently. We will be prepared to take several different routes.”

The Quiej-Alvarez twins were born in a small hospital in Guatemala on July 25, 2001. The hospital called the Guatemalan Pediatric Foundation, which then contacted Healing the Children, a nonprofit group that finds medical care for children in undeveloped countries. The organization approached Lazareff, one of HTC volunteer physicians, for aid in accepting the twins’ cases. Lazareff and Kawamoto are leading the team of UCLA physicians, nurses and medical staff who are working with the twins.

Craniopagus twins — those who are fused at the tops of their heads — are one of the rarest types of conjoined twins. An estimated two percent of conjoined twins are craniopagus.

While many of the UCLA physicians - including Lazareff and Kawamoto - are donating their services - Mattel Children’s Hospital expects the babies’ care to cost upwards of $1.5 million. To recover some of these expenses, the hospital has established a fund called Twins Care at UCLA. Checks payable to UCLA Foundation may be mailed to UCLA Medical Sciences Development, 10945 Le Conte Ave., Ste. 3132, Los Angeles, CA 90095.

Healing the Children is also accepting donations on behalf of the twins at Box 221478, Newhall, CA 91322. See for more details.

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