Surgical separation gives boys new life

The recovering 3-year-olds are almost ready to walk.
VALHALLA, N.Y. (AP) -- One year after a neurosurgeon separated them by cutting through a section of brain, Carl Aguirre says "Wow!" as he whizzes a toy truck off the tray of his high chair, and his brother Clarence holds his nose to let his mother know his diaper is dirty.
After "starting their life over," the formerly conjoined 3-year-old Filipino boys have been amazingly free of significant complications, doctors say. Clarence is about to take his first steps and therapists say Carl will soon follow.
"When they emerged from the OR as separate boys, it was almost as if that was their second birth," said Dr. Robert Marion, the boys' pediatrician. "Their motor skills are what you'd expect of a 1-year-old. They're starting to walk. They're playing appropriately in the way that a 1-year-old would. Their speech, also, is like that of a 1-year-old."
Gradual procedure
Until last Aug. 4, when they underwent the fourth in a series of major operations at the Children's Hospital at Montefiore Medical Center in the Bronx, Carl and Clarence had been unable to sit up, stand straight or see each other's face. Joined at the top of their heads, they were limited to lying on their backs, which stunted their development and subjected them to chronic pneumonia caused by inhaling food.
The boys and their mother, Arlene, came to New York in 2003, when Montefiore agreed to take the boys' case for free -- it has cost more than $3 million so far -- and the Blythedale Children's Hospital in Valhalla agreed to donate housing and therapy.
The Children's Hospital team of neurosurgeon Dr. James Goodrich and plastic surgeon Dr. David Staffenberg separated the boys in a gradual "staged" approach, pushing apart their brains and dividing the blood vessels in four operations from October 2003 to August 2004. In between, the boys were given time to heal. It was a departure from the more common single marathon operation.
Dr. Marion said Carl suffered some seizures in the month after the separation, but Dr. Goodrich said his principal fears -- neurological problems and liquid on the brain -- did not develop.
Laughing and playing
During a reporter's recent visit to Blythedale, Clarence walked proudly, holding onto a therapist with one hand and pushing his stroller with the other. He was so energetic that at one point he stepped out of his pants and staffers had to find him a belt.
Meanwhile, Carl stood, a bit unsteadily, to play a bead game on a table.
Later, the boys laughed as they tumbled down a padded slide together. Though their skulls have not yet been reconstructed -- doctors don't want to interrupt their therapy -- and specially designed plastic helmets haven't fit well, the doctors say the boys' heads are protected well enough by their bandages even for horseplay.
Arlene Aguirre tried to hide while she watched her sons' therapy session, because when they see her, the boys want to do nothing but cuddle.
"Both of them want my attention all the time," she said. "But it's very exciting that I have to deal with two children."

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