Twins Joined At The Head To Be Separated In Cleveland

DALLAS (AP) - Doctors in Ohio are planning an attempt this
spring to gradually separate 3-year-old twin girls who were born
connected at the head.

For the past 2½ years, Anastasia and Tatiana Dogaru, who are
from Italy but are of Romanian descent, have been in Dallas,
brought here by the World Craniofacial Foundation about nine months
after their birth to be evaluated for separation surgery.

The top of Tatiana's head is attached to the back of
Anastasia's. Twins born joined at the head - called craniopagus
twins - are extremely rare, occurring in about 1 in 2.5 million

The separation carries many risks - including the possibility of
brain damage, stroke or a deadly amount of blood loss - but doctors
say the twins cannot continue to live as they are. Not only is it
awkward, but their conjoined condition would lead to a variety of
medical problems.

"Without separation, the girls won't make it," said Dr.
Kenneth Salyer, the plastic surgeon who founded the World
Craniofacial Foundation and serves as chairman of the board. "And
with separation it's a high-risk operation."

The twins and their parents will travel in April to Rainbow
Babies & Children's Hospital in Cleveland, where a team of doctors
will separate the girls in stages.

The twins spend their days much like any other young girls:
dressing up like princesses, coloring, drawing, playing house and
reading books. They easily get around their Dallas apartment with
Anastasia leading the way as Tatiana follows.

"Like every mom, I want just normal kids," said their mother,
Claudia Dogaru, 31. She said that right now the girls - who are
speaking English and Romanian - are developmentally on target.
Not only do the girls share numerous of blood vessels, but
Anastasia - the larger twin - has no kidney function and relies on
Tatiana's kidneys.

Separating their blood vessels is likely to take four stages, so
Anastasia will have to begin dialysis. After recovering for a
couple of months after the separation, Anastasia will then undergo
a kidney transplant, with one of her parents being the likely

As the process begins to separate their blood vessels, doctors
will be watching to make sure that Tatiana's venous drainage system
- which does not function as well as her sister's - begins
operating as it should.

"Unless we can see that happen, Tatiana could not survive the
separation," said Dr. Arun Gosain, a member of the team that will
separate the girls and chief of pediatric plastic surgery at
Rainbow Babies & Children's Hospital and medical director for the
Rainbow Craniofacial Center. In that case, doctors will need to
re-evaluate the surgery, since the objective is for both girls to
survive, he said.

Doctors say that it appears the girls only share a small portion
of brain matter. Before their final separation, the girls will have
had skin expanders placed in their heads to make sure there's
enough to cover their brains once they are separated, Gosain said.

Since the girls arrived in Dallas, the World Craniofacial
Foundation has been paying their living expenses and providing
therapies. The Dogaru family sought out the foundation after
hearing about the successful separation in 2003 of Egyptian
conjoined twins. The boys, who were joined at the tops of their
heads, were brought to Dallas by the foundation and separated at
Children's Medical Center Dallas.