Two-year-old conjoined twins from the Philippines who are joined at the top of their heads were wheeled into an operating room Wednesday morning for surgery that could climax with their separation.
Carl and Clarence Aguirre, already veterans of three major procedures, went into the operating room around 7:30 a.m. for anesthesia and other preparatory work, said Steve Osborne, a spokesman for the Children's Hospital at Montefiore Medical Center in the Bronx.
Their mother, Arlene Aguirre, and grandmother, Evelyn Aguirre, accompanied the feisty, dark-haired boys to the door of the operating suite and tearfully kissed them goodbye, Osborne said.
The long, delicate operation was expected to begin later in the morning.
Doctors have taken a surgical approach employed only a few times before on conjoined twins, replacing the typical marathon two-day separation surgery with four shorter procedures over 10 months.
Most of the blood vessels around the brain had been cut and divided already, and the boys' brains have been partially separated.
The lead doctors, neurosurgeon James Goodrich and plastic surgeon David Staffenberg, had expressed satisfaction with the boys' readiness for separation, but said that they would postpone it if any warning signs arose, such as swelling or bleeding.
The plan for Wednesday called for making a "window" in the skull, cutting the last major vein still being shared by the brothers, then teasing apart their separate brains in the one small area that had not already been separated.
Once they decided to go ahead, the doctors would complete the separation by removing much of the remaining skullbone. They would have to reconstruct the membrane that cover the brains, and cover the heads with skin.
The doctors have donated their services, as have Montefiore and Blythedale Children's Hospital in Valhalla, where the twins have been living between surgeries and receiving physical therapy.
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On the Net:
Montefiore Medical Center, http://www.montefiore.org
