For seven months the blond, chubby-cheeked twins ate, slept, cried, had their diapers changed, just like babies everywhere. But they gazed at the world around them from an awkward and virtually immobilizing position. The two were joined at the back of the head, with their faces turned Janus-like in opposite directions. Sitting up or crawling was impossible. By the time they were brought to Johns Hopkins Children’s Center in August, they weighed a total of 30 lbs. — too heavy and clumsy a bundle for their mother to carry easily. Last week, for the first time in their brief lives, Patrick and Benjamin Binder of Ulm, West Germany, lay in separate cribs. Benjamin rested next to his stuffed dog, Patrick with his teddy bear nearby. They had been parted during an operation of staggering complexity and delicacy — five months in the planning, 22 hours in the execution, and involving 70 doctors, nurses and technicians. The procedure required draining all the blood from the boys’ bodies and completely stopping their heartbeat. At week’s end both were in critical but stable condition. Until the babies are roused from drug-induced comas, doctors cannot fully assess their health. “Success in this operation is not just separating the twins,” says Dr. Mark Rogers, who coordinated the effort. “Success is producing two normal children.” The Binder twins represent a rare natural anomaly. Siamese twins, who usually die at or before birth, occur in only one out of 100,000 deliveries, the result of an incomplete division of the fertilized egg in forming identical twins. Only one out of every 2 million births produces twins who are joined at the head. Because of the way the Binder babies were attached, their prospects were especially bleak. Without surgical intervention, says Rogers, who is chief of pediatric intensive care, “they would have had to remain bedridden for as long as they lived.” The difficulties of separating them were clear from X rays. The boys had separate brains, but they shared a major vein in the back of the head called the sagittal superior sinus, a large canal through which blood flows toward the heart. Past efforts to separate similarly joined twins had resulted in either death or brain damage. Indeed, one such attempt by doctors in Chicago in 1981 ended tragically with both children bleeding to death on the operating table. Theresia, 20, and Josef Binder, 36, searched in their own country and the U.S. for a medical team that could offer their sons a better prospect. The surgical plan, initiated by Rogers and Pediatric Neurosurgeon Ben Carson, combined several intricate procedures. To avoid major hemorrhaging in the brains, they proposed to drain the boys’ blood supply completely and stop the hearts. To prevent the brains and other organs from starving during this period without blood-borne oxygen and nutrients, metabolic demands would be reduced to a minimum by lowering the babies’ body temperature to 68 degrees F, putting them into a state of suspended animation. Because their brains are resilient, children below the age of 18 months have a remarkable capacity to recover from induced hypothermia, which is frequently used in pediatric heart surgery. Even so, doctors figured that once the hearts were stopped, the doctors had no more than one hour to complete the separation and reconstruction before irreparable damage would occur.
