Baby improving after doctors remove second head

BENHA, Egypt - Egyptian doctors said a 10-month-old girl suffering from one of the rarest birth defects was in a serious but improving condition after they removed her second head in an operation on Saturday.

As in the case of a girl who died after similar surgery in the Dominican Republic a year ago, the second twin had developed no body. The head that was removed from Manar Maged had been capable of smiling and blinking but not independent life, doctors said.

Video footage provided by the hospital, a national centre in Egypt for children's medicine, showed Manar smiling and at ease in a cot with the dark-haired "parasitic" twin, attached at the upper left side of the girl's skull, occasionally blinking.

Manar has craniopagus parasiticus -- a problem related to that of conjoined twins linked at the skull.

Abla el-Alfy, a consultant in paediatric intensive care, told Reuters at the hospital in Benha, near Cairo, that they were still working on Manar Maged.

"After surgery ... you get unstable blood pressure, you get fever. But she is stabilising," Alfy said. "We have some improvement."

After the 13-hour operation, Reuters journalists saw the baby, her head swathed in bandages and body wreathed by tubes, in an intensive care ward. A separate twin sister, Noora, is healthy after initial problems with the birth on March 30.

Alfy said the 13-strong surgical team separated Manar's brain from the conjoined organ in small stages, cutting off the blood supply to the extra head while preventing increased blood flow to Manar's heart, which would have risked cardiac arrest.

Benha, 40 km north of Cairo, was chosen for its equipment and proximity to the girl's family. "The family of the child are from near here, we have the equipment, we assembled a team, so why not have the operation here?" she said, explaining the choice not to work in Cairo or at centres abroad with more experience with conjoined twins.

MONTHS OF PREPARATION

Alfy said Manar's skull had been reconstructed during surgery and her skin had been joined over the bone, leaving no need for further reconstructive surgery.

The doctors decided not to carry out Manar's operation soon after her birth: "We studied the babies well," Alfy said. "We had to study how the blood supply of the parasite is working."

She plans to keep Manar in intensive care for up to 10 days and remains cautious: "Things are getting better but ... at any time things can go wrong."

The condition occurs when an embryo begins to split into identical twins but fails to complete the process and one of the conjoined twins fails to develop fully in the womb.

The second twin can form as an extra limb, a complete second body lacking vital organs, or, in very rare cases, a head.

Last February, seven-week-old Rebeca Martinez died in the Dominican Republic after surgery to remove a second head.

The leader of that team, Jorge Lazareff of the University of California at Los Angeles, noted on viewing one picture of the Egyptian baby that the face of the undeveloped twin was "very well developed" compared to that in Rebeca's case.

"Rebeca ... had a more vertical sibling, whereas (in) this the second growth is tangential," he told Reuters, while noting he had not previously been aware of the Egyptian child.

- REUTERS