NEW YORK — Twin baby boys conjoined at the head were successfully separated early Friday at the Children’s Hospital at Montefiore Medical Center in the Bronx.
Jadon and Anias McDonald, 13-month-old twins, were still undergoing surgery at 6 a.m. to reconstruct their skulls and make them whole.
The surgery was led by Dr. James Goodrich, considered the leading expert on what’s known as craniopagus surgery. The separation part of the surgery took nearly 16.5 hours.
It marked the seventh separation surgery performed by Goodrich — and just the 59th craniopagus separation surgery in the world since 1952.
Their parents, Nicole and Christian McDonald, had to make an agonizing decision, opting for the procedure even though it carried major risks, including the possibility of death or long-term brain damage for one or both boys.
Goodrich informed the family of the separation around 3 a.m.
“Well, we did it,” Goodrich said.
On her Facebook page, Nicole wrote: “TWO SEPARATE BABIES!!!…and yet I ache with the uncertainty of the future. I didn’t cry until the surgeons left the room. I was barely able to even utter the words ‘thank you’ because of the pit that still sits heavy in my stomach. We are standing on the brink of a vast unknown. The next few months will be critical in terms of recovery and we will not know for sure how Anias and Jadon are recovering for many weeks.”
The moment capped an end to an agonizing wait for the boys’ parents.
The McDonalds and Montefiore hospital invited CNN to document this remarkable and rare journey of Jadon and Anias, allowing CNN exclusive access into the operating room throughout the procedure.
Yet before Nicole and Christian learned their boys were now two individuals, Thursday was a day of high emotion and high stakes, of anxious parents and calm medical professionals. It was a day of unchartered territory and amazing, one-of-a-kind surgical activity.
And amid it all were two infants — beautiful boys with deep brown eyes and a shared swirl of hair at the top of their foreheads. They came into the world together, and became two individual boys overnight.
‘I feel good’
It’s been 12 years since Dr. Goodrich last separated twins conjoined at the head at Montefiorre. That was his first ever craniopagus surgery, and he’s learned much since then, performing five other separation surgeries around the world, including Syrian twins in Saudi Arabia earlier this year.
Prior to the mid-1980s, it was accepted medical practice to sacrifice one child on the operating table to save the life of the other. Many times both babies died. If one child made it through surgery, he or she often suffered debilitating brain damage.
Goodrich has pioneered the field. He established the practice of performing the separation of craniopagus twins in several shorter stages, instead of one single operation lasting more than 50 hours. The McDonalds have had three previous operations, each resulting in progressively more separated brains. Today was the fourth and final stage. None of Goodrich’s conjoined twins have died during the operation. His mantra: “Take it easy and slowly and carefully.”
‘Failure is not an option’
In a waiting area off the operating room, Goodrich and Dr. Oren Tepper, the plastic surgeon, huddle with neuroradiologist Joaquim Farinhas.
Farinhas shows off a three-dimensional replica of the boys’ brains vessels that can be pulled apart, revealing exactly how they are fused together. The boys share about an inch-and-a-half diameter of brain tissue.
“This is what I wanted you to see,” Farinhas says, “which is something that is soft and you can actually poke in and cut through.”
Goodrich studies it for a bit before saying, “Ready to rock-n-roll.”
“Absolutely,” Farinhas says.
“Failure is not an option,” Goodrich replies.
For the next two hours, the boys are prepped for surgery.
‘The easiest part is done’
The next several hours are a whir of activity. In the three previous surgeries, the surgical team added tissue expanders to stretch the skin to make sure there was enough to cover their new skulls. Surgeons also separated some of the veins to make way for today’s final separation.
The family holes up in the Caregiver Support Center, two floors and two corridors away from the operating room. Shortly after CNN first published a story about the family Thursday morning, Nicole and Christian start getting swamped with messages, from friends and strangers alike. They monitor the hashtag #JadonAndAnias and watch as thousands of dollars in donations pour into their GoFundMe page.
They’re buoyed by the messages of support from people as far away as the Philippines and Germany. They say their faith is renewed in mankind — that it’s a nice break from sordid headlines and the hotly contested political season.
“Everybody is really showing how much they love these boys,” Christian says. “I didn’t realize how many people are out there have so much good in them and how much they want to help.”
By noon, the surgical team has taken out one tissue expander and removed some temporary plates that were inserted in the earlier surgeries to hold bone back.
At 12:04 p.m., it’s time to turn the boys to get to a new area to cut — a delicate maneuver that requires all hands on deck.
“1, 2, 3, lift!” a team member says.
Jadon’s shoulders rotate 45 degrees. They adjust Anias into a similar position. Tepper remains calm, continuing his work.
Goodrich stands and turns away from the table and studies a 3D replica of the boys’ conjoined skulls.
Soon, Goodrich returns to the table. Working diligently with him is Tepper and three other surgeons: Dr. Rani Nasser and Dr. Ajit Jada, both chief residents of neurosurgery, and Dr. Carrie Stern, chief resident of plastic surgery.
At 1:55 p.m, more than four hours into the surgery, Goodrich turns around and says, “The easiest part is done.”
Fifteen minutes later, a chunk of skull is removed. No time to rest. The surgical team presses on. They take out a second tissue expander shortly before 3 p.m.
The most critical phase
Shortly before 9 p.m., the operating room intensifies. The surgeons have reached their most critical phase: They must separate the shared blood vessels between the two boys. Veins are very thin walled, and one section of Jadon and Anias’s brains are intricately tied together.
A single cut that goes too deep can lead to catastrophic bleeding.
Neuroradiologist Joaquim Farinhas stands in front of the screen displaying the 3D computer model. He calls Dr. Ajit Jada over from the operating table and points at the cluster of veins. Farinhas dispenses advice. Jada returns to the table.
“Be very gentle with Anias’s side,” Farinhas calls out to the surgical team.
Tepper, who had taken a brief break, returns to the table.
“It’s a bear,” says Farinhas.
“This is the most important part,” he explains, “because the vessels are so delicate and they’re so complicated. It’s almost a lake of veins that they’re trying to negotiate. It’s pretty amazing.”
The surgical team has to figure out: How do you tie it off safely? How do you negotiate it safely? How do you separate it?
At 9:18 p.m., Goodrich says, “We just closed off the sagittal sinus.”
The last stitch
Seconds tick off into minutes, which turn into hours.
The surgery is meticulous, tricky, complex. And that’s an understatement.
At 1:18 a.m., Tepper, the plastic surgeon, steps to a nearby metallic table and takes a special saw to split a removed skull piece into two. Those two pieces will be used for the boys’ new skullcaps.
Goodrich and his team continue to work away toward the moment of separation. At about 1:40 a.m., he sits in a seat next to the operating table with hands crossed, as if admiring the work. Moments later, he stands and dives right back into surgery.
At 2:10 a.m., Goodrich says, “One more inch.”
“We’re ready. You ready?” one surgeon says.
“Yep,” Goodrich says.
It’s a badge of honor as to who gets the last cut when separating conjoined twins.
“The last stitch,” Tepper says. “Who wants it?”
The only woman surgeon at the table, Dr. Carrie Stern, makes the historic last cut, at 2:11 a.m.
“We are official,” Goodrich says.
The room bursts into spontaneous applause.
After nearly 16 and-a-half-hours, the boys are separated.