In three days, 29 year-old twins Ladan and Laleh Bijani may part ways -- for the first time.
A marathon operation began yesterday at Singapore's Raffles Hospital to separate the Iranian sisters' conjoined brains, an extremely delicate procedure that has only a 50-50 chance of both women surviving.
The surgery, which marks the first time an attempt has been made to separate adult twins joined at the head, is being performed by a team of 28 doctors from around the world, with the assistance of more than 100 medical support staff. In contrast, craniopagus infants, whose brains can more easily adapt and recover to the procedure, have been operated on successfully since 1952.
If all goes well and physicians are able to separate the twins' shared sagittal sinus -- the principal blood-draining vein, usually as thick as a finger -- both sisters will live healthy lives apart from one other. Currently, high levels of pressure exist between their otherwise distinct brains, which could lead to impaired vision and deteriorating brain function if left untreated.
Laleh already suffers from chronic headaches, according to representatives at Raffles Hospital.
"This is something quite necessary, not cosmetic or frivolous," said the operation's leader, Singaporean neurosurgeon Keith Goh.
Four days are needed to not only complete the neurosurgical operation, but also to undergo a complicated plastic surgery procedure to close the cavities in the twins' separated skull with grafted muscle and skin.
For the law-school graduate twins, however, it's worth all the risks. After nearly 30 years of two very different personalities being forced to compromise on every aspect of daily life, they said they would rather face the surgery's dangers than continue living in their conjoined state.
"We would like to see the face of each other without the mirror," Laleh said at a June press conference, sharing a traditional headscarf with her sister.
"When we opened our eyes to see the light, we wanted to be separated," Laden added. "We have a lot of work and dreams to do after surgery ... if God wants us to live the rest of our lives as two separate, independent individuals, we will."
And though they normally shun the spotlight, the twins released a letter last week to thank their friends and supporters worldwide.
"Both of us have started on this journey together and we hope that the operation will finally bring us to the end of this difficult path," they said, "and we may begin our new and wonderful lives as two separate persons."
Iranian President Mohammad Khatami, too, hoped for a successful surgery.
"The prayers of the Iranian nation are with you," Khatami said to the international team of doctors, which included American members. "I hope to see my patient daughters Laleh and Ladan healthy and fresh as soon as possible."
The $288,000 cost of the operation is being underwritten by Raffles Hospital, and all doctors' fees are being waived.
According to the Johns Hopkins Children's Center, conjoined twins, which form when a single fertilized egg fails to divide completely to create two distinct individuals, occur once in every 70,000 to 100,000 live births. Conjoined twins. Twins joined at the head occur approximately once in every 2 million live births.
"In general, the greatest risks to conjoined twins during and after separations are anesthesia and surgical complications," a statement issued by the Children's Center said. "In this unique case of separating adult conjoined twins, there are psychological issues that will have a significant effect on both, even after a successful separation."
The Associated Press contributed to this report.
