Siamese twins occur only once in 100,000 births. Those joined at the head, like the Guatemalan twins recently separated at UCLA are the rarest of all, occurring in less than one in a million births. UCLA, which has one of the world's leading neurosurgery centers is not the first operating theatre where a successful attempt was made to separate "craniopagus" twins who shared some of their neurological "wetware." That honor belongs to Vienna's university hospital and a team headed by pediatric neurosurgeon, Dr. Wolfgang Koos and American neurosurgeon, Dr. Robert Spetzler.
Step by step, "The Healing Blade" describes the operation performed on the conjoined twins. The surgeons had been rehearsing each step, "together and apart, through three months" to acquire the necessary precision of movement. The operation itself took place over a period of days. Sylvester describes the scene before it began:
"At the juncture of the twin operating tables lies what appears to be a log of ironwood, dried pale and clean. It is the long, common skull of the twins, shaved of that fringe of curly brown hair. Nearly a foot apart two small [three-year-old] faces appear carved into the wood, one facing straight out, one cast slightly downward, both in slumber, perfect cherubim carved into the column of their skull."
Read this fascinating account if you are at all interested in the fate of the Guatemalan twins at UCLA. Unfortunately, the twins who were separated in Vienna later died of infection, so this is a cautionary tale. We must not become too optimistic, even though the surgery was successful:
"In 30 attempts worldwide to separate twins joined at the head, from 1928 to 2000, only seven of the 60 children came through the surgery without brain damage; 30 died, 17 were neurologically impaired and the remainder of the cases were reported before the ultimate outcome could be determined, according to the medical journals [NY Times 08/07/2002]."
Other operations performed by Dr. Spetzler had more successful, long term outcomes as described in "The Healing Blade." This book focuses on three main subjects: Dr. Spetzler and his contributions to neurosurgery; the history of the Barrow Neurological Institute in Phoenix, where Dr. Spetzler performs the majority of his operations; and a new state of the art procedure called the "Standstill," which is a nickname for hypothermic arrest. In a sense, the patient dies for an hour--no blood and therefore no oxygen can reach his brain while he is chilled down to the point where his heart stops.
This book is much more unputdownable than the latest techno-thriller by, say Clancy or Ludlum, because it is true. The author's attention to detail places us right into the operating room with the surgical team, and deep into the magical cavern of the human skull. The only dry stretches of text concern the founding and history of the Barrow Neurological Institute, and they don't take up too much room. The author also works in a brief history of neurosurgery, but none of it is quite as fascinating as the scenes where Dr. Spetzler is poised over his intraoperative microscope, carefully dissecting an aneurysm that threatens to explode through the micro-currents of a human intelligence.