University Communications

Fall 2002
The Little Marias
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At first "it was very hard to give the OK to do this because it is a very significant financial risk," says Michael Karpf, director of UCLA Medical Center. "But after seeing those kids, it was an easy decision. They're very much distinct human beings who need every opportunity to be distinct human beings. This is UCLA doing the right thing."

Lazareff adds: "We are standing up for what a hospital is supposed to be — an institution that stretches out its hands to help people in need."

ON JUNE 7, MARIA TERESA AND MARIA DE JESÚS are flown with their mother from Guatemala to UCLA on a private jet provided by an anonymous donor. (Their father would arrive two months later.) During the flight, a charity volunteer sets up a mirror, and with it the girls are able to see each other for the first time. Although they cannot see each other's face because of the angle at which they're connected, the girls stop rolling around and become absorbed in looking at one another in the mirror.

Maria Teresa and Maria de Jesús are craniopagus twins, meaning they are joined at the skull. It is the rarest form of conjoined twins, believed to occur in just one in 1.5 million live births. Once at UCLA, the girls begin to undergo extensive tests. And the surgical team discovers some good news: The twins have two substantially distinct brains under a shared skull. However, separation will be extremely complicated because of the neural and vascular connections between the two brains — the twins share some venous drainage. And if the surgeons can't preserve or reroute the veins, Lazareff says, the twins could be at risk for stroke. But no matter how many angiograms, MRIs and 3-D scans are taken and studied, in the end, the doctors will not know for certain the extent of the shared drainage until they look inside. So they prepare for every possibility.

"We have Plan A, we have Plan B, B prime," says Henry Kawamoto Jr., surgical director of the UCLA Craniofacial Clinic. "If the juncture comes and we need a backup, we have a plan for it. That planning is infinitely more difficult than the actual operation."

Fortunately, the team never has to veer from Plan A.

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