Egyptian girl 'will soon be able to breathe on her own'

A 10-month-old girl was beginning to move her limbs with ease, steadily improving after an operation last week that removed a second head sharing a blood vessel with her own brain, one of her doctors said yesterday.

Manar Maged was born March 30, 2004, with a rare birth defect, craniopagus parasiticus, that occurs when an embryo begins to split into identical twins but fails to complete the process, leaving an undeveloped conjoined twin in the womb. Manar also has a healthy twin sister, Noora.

"Manar Maged is in a stable condition - no fever, no bleeding, no problems and no post-surgery complications," said Dr Naseif Hefnawi, director of Benha Neonatal Hospital.

Hefnawi, a member of the team that operated on February 19 on Manar, said the "girl's brain is regaining its activity, her breathing is regulated and she moves her limbs easily and normally". Hopefully, he said, Manar can be removed from a ventilator and transferred out of the Intensive Care Unit in about a week.

Hefnawi said the girl's liver, which had not functioned normally since the February 19 surgery, would not be a big problem once medications were stopped. Another problem, related to her blood not coagulating properly, is not a serious problem now, he added.

During surgery, Manar bled extensively because of the major blood vessel that had to be severed and there were complications in the day after the surgery, including unstable blood pressure, hypothermia, poor liver function and the blood not coagulating.

Doctors have said the 12-hour surgery, carried out in the Nile Delta town of Benha, some 40km north of Cairo, was the first of its kind in the Middle East.

The head that was removed from Manar in the operation had developed no body, and was capable of smiling and blinking, but not independent life.

"At the moment only about 15 per cent of her breathing is through the ventilator and in about 48 hours we will switch off the ventilator," Abla Al Alfy, a consultant in paediatric intensive care, said.

Al Alfy, part of the team of 13 Egyptian doctors who carried out the operation, said it was too early to say whether Manar could have suffered brain damage.

"In four days or less we will do a ... scan of her brain to see what the situation is," Al Alfy said.

Professor Lewis Spitz, a leading expert on conjoined twins at Great Ormond Street Hospital in London, said the vital question for Manar was whether brain tissue and blood vessels were shared between the two heads.

He said it was critical that the blood flow away from the surviving twin was not interfered with during separation.