Ben Carson

"Gifted Hands: The Ben Carson Story" premiered tonight on TNT and will no doubt air again. Dr. Carson is a world-renowned neurosurgeon at Johns Hopkins in Baltimore. He has separated - and consulted on the separation of - several pairs of conjoined twins. He figures in two entries in my Conjoined Twins book, which I have abbreviated below:

Banda, Luka and Joseph. Conjoined twins born in Zambia in 1997, the Banda babies were joined on the top of their heads and facing opposite directions. Their skull was described as one continuous tube, but the brains themselves were not joined. The twins were separated in South Africa by a team of twenty doctors and nurses led by pediatric neurosurgeon Dr. Benjamin Carson. In preparation for the 28-hour surgery, Dr. Carson practiced on a virtual reality device that created a three-dimensional replica of their brains from MRIs, including every detail of their complex shared blood supply. The operation involved separating numerous blood vessels, nudging the brains apart, covering the exposed skulls with tough cow membrane, and suturing the scalp closed.

After 19 hours of surgery, Dr. Carson had the boys’ heads separated 3/4 of the way, but was afraid they would bleed to death. He suggested leaving the twins partially linked for weeks or months to allow their brains to develop alternate pathways for blood, but the plan was scuttled because the hospital lacked the facilities to keep the boys alive in a partially divided state. Dr. Carson remembers, “After twenty-eight hours and after a point where we almost gave up again because the vascular anatomy was so complex, they woke up. Now one of them right in the operating room popped his little eyes open and reached up for the tube and tried to extubate himself. The other one was doing the same thing by the time we got to the intensive care unit. Within two days they were extubated, within three days they were eating, and within two weeks they were crawling around, neurologically intact, and it was just unbelievable.” The Banda twins would wear helmets for the next year to protect their heads from injury. Unlike the Binder twins, the Bandas did not suffer from any neurological deficits after the separation.

Binder, Patrick and Benjamin. Conjoined twin boys born by Cesarean section in Ulm, Germany, in 1987, the Binder twins were joined at the back of the head and shared the superior sagittal vein, the major vein that drains blood from the brain, in addition to skull and skin tissue. If surgery were not performed, the twins would be bedridden the rest of their lives. Consulted about the case, Johns Hopkins assembled a team of 70 and prepared for 5 months, including conducting 3 dress rehearsals. They equipped the operating room with a hinged table and two of everything else. After inflatable silicone balloons were inserted under the scalps of the boys to stretch the skin, they were transported to Baltimore for separation by pediatric neurosurgeon Ben Carson. In his book Gifted Hands, he describes, “At the end of the five-month period, everything was so organized that at times it felt as if we were planning a military operation. We even worked out where each team member would stand on the operating room floor. A 10-page, play-by-play book detailed each step of the operation. We endlessly discussed the five 3-hour dress rehearsals we’d had, using life-sized dolls attached at the head by Velcro.”

The operation took 22 hours. After opening the dura and separating the brains, the team encountered bleeding that was difficult to control because of the size and shape of the shared vein. The babies were attached to heart-lung bypass machines and their temperatures reduced to 68 degrees, bringing them into hypothermic arrest for what Newsweek called their "untethering." Carson and team fashioned a new sagittal vein for one of the twins from pericardial tissue, within the 1-hour time frame allowed for the bypass. Bleeding ensued and was made worse because their blood had been thinned for the bypass. The babies required 60 units of blood before the hemorrhaging eventually stopped.

The boys were put into a barbiturate coma to slow down the swelling. They were attached to life-support machines for two weeks so that their blood flow and respiration could be reduced and monitored during healing. After the operation, the media were told that the boys had a 50: 50 chance of survival. They underwent 22 additional surgeries, including an operation to insert a titanium mesh covering mixed with a paste of crushed bone where each boy had shared a skull to improve the closure of the scalps. Almost all post-operative emergencies were brought under control quickly except a respiratory arrest suffered by Patrick, who aspirated some food. He was deprived of oxygen for an unknown length of time, but made a good recovery. Nevertheless, the twins had severe neurological deficits after the separation that left them institutionalized.