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UCLA Magazine Fall 2002
The Little Marias
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Fall 2002
The Little Marias
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Neurosurgeon Jorge Lazareff (left) and plastic and reconstructive surgeon Henry Kawamoto (right) discuss the girls' positioning on the operating table.

"The difficulty was that we had two patients who were attached and who shared venous cerebral circulation, which means when we gave drugs to one, it affected the other," Van de Wiele, director of neurosurgical anesthesiology, continues. "That's a very unique circumstance." The team learned this before the girls' first angiogram, shortly after they arrived at UCLA. They gave Maria de Jesús the drug Atropine, which increases the heart rate, and within seconds Maria Teresa's heart rate also increased. For the surgery, General Electric Co. provided two extra monitors so that each twin's anesthesia team could see the vital signs of both girls simultaneously and pick up on any trends.

Positioning the twins also is critical. Prior to the operation, the medical team, working with plastic molds of the girls' heads that had been cast and donated by Biomedical Modeling Inc. of Boston, at a cost of $10,000, spent many hours figuring out how best to position the children so the surgeons could work on both simultaneously without having to move them or turn them over during the operation. They also wanted them properly positioned so that at the moment of separation they could rotate the tables apart and the two plastic-surgery teams could immediately start work on each of the girls.

Even with such preparation, the team has to improvise when it comes time to do the actual surgery. "Positioning is really what this whole case is about," Van de Wiele says. "And it really takes teamwork between the surgical, nursing and anesthesia teams to achieve optimal positioning."

Once the girls are secured and their thick, black hair is shaved off, Kawamoto and his team set to work mapping out their approach, using a high-tech Doppler ultrasound wand and a low-tech black Sharpie marker to draw a line around the girls' scalp where the incisions will be made.

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