University Communications

Fall 2002
The Little Marias
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Lazareff, who first brought the twins to UCLA's attention, calls the girls' mother to give a quick update on their condition.

At 2:38 p.m., Lazareff and the neurosurgery team begin removing a rim of bone — about two-thirds of the circumference of the shared skull — to allow the doctors to see the dura, the fibrous membrane that envelops the brain. Then the girls are given Mannitol, a medication to remove water to shrink their brains, a standard procedure in brain surgery.

Nearly four hours later, at 6:22 p.m., the neurosurgeons begin to enter the brain, identifying the veins, collapsing them and rerouting the blood supply to each of the twins. It is an achingly slow procedure, but necessary to avoid the possibility of a stroke. For each clamped vein, the stop-clock on the wall is set for 20 minutes. During that time, the girls' brain waves are measured; if in that time the EEG doesn't drop, the team continues on to the next vessel. Throughout the process, the anesthesiologists keep an especially watchful eye on Maria Teresa - her blood volume will be replaced 12 times before the operation is over; her sister's will be replaced three times. (The medical team had anticipated the need for copious amounts of blood, and 100 members of the UCLA community had answered a call to donate blood for the girls.)

When that procedure is finished, the neurosurgeons and plastic surgeons begin to work from underneath the operating tables to remove the remaining portion of dura and bone.

Finally, at 12:56 a.m. the next day — just over 11 hours after the first incision is made — a doctor announces, for the record, "They are separated." A brief moment later, Lazareff, realizing what has been achieved, adds: "You are looking at two children, two little girls. There will be two passports, two boyfriends, two weddings."

But there is no time for celebration. The surgery is only about two- thirds complete. The twins are still connected by a flap of skin and it is time for Kawamoto and the plastic-surgery team to make the final cut and begin the process of reconstruction.

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