Mateo and McHale's story

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Patient Spotlight - Mateo and McHale's story

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Mateo and McHale were conjoined twins who were successfully separated by a multidisciplinary team from Children’s National in a 19-hour surgery on September 6, 2009. The entire surgery was carefully planned by a team of more than 100 pediatric specialists. Mateo and McHale were joined at the spinal cord and have a split cord malformation. In addition, both boys have spina bifida and hydrocephalus, as a result of the spina bifida. Read more about the complex separation surgery. The boys were born on May 10, 2006. The boys were delivered by high-risk Caesarian section at Washington Hospital Center. A total of 50 medical professionals from both the Hospital Center and Children’s National Medical Center were involved in the delivery. As soon as the twins were stabilized, Children’s Transport Team prepared the twins for the three-minute transport from the operating room to a waiting ambulance that whisked them to Children’s Neonatal Intensive Care Unit.

On May 12, 2006, Mateo and McHale had a procedure to insert drains and close McHale’s exposed spinal cord (myelomeningocele).On June 23, 2006, the boys had another procedure to insert tissue expanders under their skin to prepare for the separation surgery and insert a ventricular access device into their heads to drain fluid as a result of their hydrocephalus.

They are from Sheboygan, Wisconsin. They arrived in Washington, DC, on April 17, when Angie was 28 weeks pregnant, in preparation for the delivery. The boys were delivered at 32 weeks gestation.

Surgical Team
Medical Team
Support Team

SURGICAL TEAM

Robert F. Keating, MD. Division Chief, Neurosurgery

Robert Keating, MD
Specialty: Pediatric Neurosurgery

Role: Dr. Keating was the lead surgeon on the Shaws’ case and led the separation of the spinal cords and neurological function monitoring.

John Myseros, MD
Specialty: Pediatric Neurosurgery
Role: Dr. Myseros worked with Dr. Keating on neurosurgery. Initially, Drs. Keating and Myseros simultaneously insert ventricular drains into each child’s head to address their hydrocephalus. Next, the neurosurgery team exposed the spinal cords and nerve roots of Mateo and McHale, allowing access not only for the surgery, but for physiological monitoring. This monitoring allowed the doctors to determine literally whose nerves belong to whom. This helped enable the neurosurgery team to preserve optimal neurological function for each boy during the separation of the spinal cord, particularly considering that early physiological monitoring indicated some “cross signaling” of nerves from each boy’s brain to the other’s limbs.

Philip C. Guzzetta, MD, General and Thoracic Surgery

David M. Powell, MD, General and Thoracic Surgery

Philip Guzzetta, MD, and David Powell, MD
Specialty: Pediatric General Surgery
Role: Drs. Guzzetta and Powell led the isolation of the boys’ organs, as well as separation of muscle, tissues and their gastro-intestinal systems. Drs. Guzzetta and Powell also performed colostomies on both boys.

Michael J. Boyajian, MD, Plastic and Reconstructive Surgery

Michael J. Boyajian, MD, and Ananth Murthy, MD
Specialty: Pediatric Plastic and Reconstructive Surgery
Role: Drs. Boyajian and Murthy implanted Mateo and McHale’s tissue expanders and removed the tissue expanders for surgery. As the final step in the surgical separation of Mateo and McHale, the boys’ surgical wounds were closed using the skin that was grown during the last several weeks. Drs. Boyajian and Murthy is following the twins for their long-term reconstructive and cosmetic needs.

Laurel Claire Blakemore, MD, Orthopaedic Surgery and Sports Medicine

Laurel Blakemore, MD, and Lane Wimberly, MD
Specialty: Pediatric Orthopaedic Surgery
Role: Drs. Blakemore and Wimberly worked with Dr. Keating to separate the boys’ spines. The only shared bone, the sacrum (tailbone), was gently divided using very small equipment designed specifically for orthopaedic procedures in babies. The boys’ orthopaedic surgeons sought to divide the bone in a way that will protect their neural structures and blood supply.

Renee J. Roberts, MD, Anesthesiology and Pain Medicine

Karen Thomson, MD, Pediatric Anesthesiology

Renee Roberts, MD, and Karen Thomson, MD
Specialty: Pediatric Anesthesiology
Role: Drs. Roberts and Thomson serveed as the lead anesthesiologists for the separation. Their team managed the boys’ intubations and anesthesia throughout the entire surgery. Upon completion of the reconstructive surgery, Mateo and McHale were stabilized by the anesthesia teams and transported back to the NICU for recovery and post-operative care.

Hans Pohl, MD
Specialty: Pediatric Urology
Role: Dr. Pohl led the hydrocele repair, hernia repair and circumcision for the boys, as well as address any issues resulting from their Spina Bifida.

MEDICAL TEAM

Dorothy I. Bulas, MD, Diagnostic Imaging and Radiology

Dorothy Bulas, MD
Specialty: Pediatric Diagnostic Imaging and Radiology
Role: Dr. Bulas is at the forefront of prenatal imaging, renowned particularly for fetal MRI, and has many years of experience. She served as the lead physician for all of Mateo and McHale’s diagnostic imaging studies and has been involved with the case since the twins were still in utero.

Naomi Luban, MD
Specialty: Pediatric Hematology
Role: Dr. Luban is a world-renowned hematologist, authoring several textbooks on the subject. Her primary responsibility was the planning and management of laboratory testing and issues with respect to blood and blood products.

Kurt Newman, MD, Senior Vice President, The Joseph E. Robert, Jr. Center for Surgical Care

Kurt Newman, MD
Specialty: Pediatric Surgery
Role: As the Director of the Joseph E. Robert, Jr., Center for Surgical Care, Dr. Newman served in a primarily administrative role with respect to resource allocation and coordination for the case. He provided updates to the family throughout the surgery.

Billie Lou Short, MD, Division Chief, Neonatology

Billie Short, MD
Specialty: Neonatologist
Role: Dr. Short is Division Chief of Children’s Neonatal Intensive Care Unit. A prominent neonatologist, she pioneered the use of ECMO (Extra Corporeal Membrane Oxygenation) in neonates. She has cared for Mateo and McHale during their time in the NICU. As with any high-risk procedure, the boys required constant monitoring and medical care by the NICU team for an extended period after their surgery.

SUPPORT TEAM

Jesus Cepero, RN
Specialty: Intensive Care Nursing
Role: Jesus is the Director of Critical Care Nursing at Children’s. He was responsible for overseeing a large team of nurses who provided care pre-surgery and post-surgery for the boys.

Tara Taylor, RN
Specialty: NICU Nursing
Role: Tara is the nurse manager for Children’s NICU. She managed the NICU team who provided post-surgery care to the boys.

May-Britt Sten, RN, and Lizbeth Fahey, RN
Specialty: Performance Improvement Nursing
Role: The Performance Improvement team prepared action plans and contingency planning.

Debra Deeb, RN, and Chani Feldman, RN
Specialty: NICU Nursing
Role: Debra and Chani were the primary nurses overseeing Mateo and McHale’s medical care in the NICU.

Becky Cunningham, RN, Karen Cumberland, RN, Olesha Clark, RN, Rosemary Waites, RN, Willie Holbert, ST, June Simmons, ST, Tracy Clapp, ST, and Melissa Aja, ST
Specialty: Operating Room Nursing
Role: These Registered Nurses and Surgical Technicians led the nursing team for the separation surgery.

For further information about any members of the clinical team, please contact the PR department at 202-476-4500.

Stages of the surgery
Children's Press Release (May 10. 2006): Conjoined Twins Delivered at Washington Hospital Center Partnership with Children’s National Medical Center Provides Expert Resource for Complex Pediatric Maternal- Fetal Cases
Related stories

Tuesday, September 5
Wednesday, September 6 (Day of surgery)

Tuesday, September 5
12:00 noon
Expected duration: 3 – 5 hours

Mateo and McHale will be transported to the operating room for a number of preparatory surgical procedures, including central and arterial line placement, Foley catheter placement and final evaluation of tissue expanders in order to get the final go-ahead for surgery.

Upon completion of the procedures, the boys will be stabilized and transported back to the Newborn Intensive Care Unit (NICU) to spend the night with their parents.

Wednesday, September 6
Transport, induction and surgical preparation
6:00 a.m.
Expected duration: 2.5 hours

Mateo and McHale, accompanied by their mother and father, will be transported from the NICU by the neonatal transport team to the surgical suite. Their parents will hand them over to the anesthesiologists, where they will be taken into their operating room, intubated and given anesthesia. Significant care will be taken to position the boys to optimize access to the surgical field, and to avoid line compromise and complications due to the extended length of the surgery, such as pressure sores and tangling of lines as the surgery calls for repositioning the boys. During this time, the surgeons will make determinations for optimal placement of the incisions.

Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage 6

Stage 1
Neurological and Plastic Surgery
Expected duration: 6 – 8 hours

Initially, both boys’ neurosurgeons will simultaneously insert ventricular drains into each child’s head to address their hydrocephalus.

Next, the boys’ plastic surgeons will remove their tissue expanders. Since the duration of the surgery could potentially cause the shrinkage of some of the skin grown during the last several weeks if all of the tissue expanders are removed, the surgeons will need to assess whether it is best to remove all tissue expanders at this point, or to leave the ones on the side opposite where the surgeons will initially work. The biggest determinant will be the ability to protect the integrity of the overlying skin which will bear the boys’ weight during the initial hours of the surgery.

Next, the neurosurgery team will expose the spinal cords and nerve roots of Mateo and McHale, allowing access not only for the surgery, but for physiological monitoring. This monitoring will allow the doctors to determine literally which nerves belong to whom. This will help enable the neurosurgery team to preserve optimal neurological function for each boy during the separation of the spinal cord, particularly considering that early physiological monitoring indicated some “cross signaling” of nerves from each boy’s brain to the other’s limbs.

At this point, Mateo and McHale’s lead surgeon will begin the arduous and difficult process of separating the spinal cord. Again, great pains will be taken to preserve as much neurological function as possible for each boy.

Back to Stages

Stage 2
Orthopaedic Surgery: Separation of Bony Spine
Expected duration: 1 - 2 hours

The only shared bone, the sacrum (tailbone), will be gently divided using very small equipment designed specifically for orthopaedic procedures in babies. The boys’ orthopaedic surgeon will seek to divide the bone in a way that will protect their neural structures and blood supply.

Stage 3
General Surgery
Expected duration: 1 - 2 hours

This stage of the surgery involves the isolation of the boys’ organs, as well as separation of muscle, tissue and their gastro-intestinal systems. Once finished, this will complete the physical separation of Mateo and McHale.

Back to Stages

Stage 4
Transfer of one child
Expected duration: 1 - 1.5 hours

One boy will now be moved to an adjacent operating room. The current plan is to transfer the child via bassinet. Now, each boy will have his own team of surgeons who will perform any necessary reconstruction and close each boy’s surgical wounds.

Stage 5
General Surgery
Expected duration: 3 - 4 hours

Depending on the clinical picture, a general surgeon will perform colostomies on one or both boys.

Back to Stages

Stage 6
Plastic and Reconstructive Surgery
Expected duration: 2 - 3 hours

As the final step in the surgical separation of Mateo and McHale, the boys’ surgical wounds will be closed using the skin that was grown over the last several weeks.

Upon completion of the reconstructive surgery, Mateo and McHale will be stabilized by their anesthesia teams and transported back to the NICU for recovery and post-operative care.

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Back to Stages

Conjoined Twins Delivered at Washington Hospital Center Partnership with Children’s National Medical Center Provides Expert Resource for Complex Pediatric Maternal- Fetal Cases

Washington, DC –Washington, DC, May 10, 2006- Conjoined twin boys were born this morning at Washington Hospital Center. The twins are joined at the back. The high-risk Caesarian section delivery went as planned and involved five medical teams from the Hospital Center and Children’s National Medical Center. Mom Angie Benzschawel is in good condition and twins Mateo and McHale are in critical but stable condition in Children’s Newborn Intensive Care Unit (NICU).

“After months of waiting, it was a relief for us to finally meet the boys,” said father Ryan. “We appreciate the support of everyone involved. We hope everyone will respect our request for privacy as we focus on the care of our twins.”

David Downing, MD, associate chair, Obstetrics and Gynecology at Washington Hospital Center headed the maternal and fetal medicine team. Dr. Downing praised his team for bringing mom and the twins through the challenges of this pregnancy. “We provided high-risk monitoring of mom and the fetuses on a daily basis,” said Dr. Downing “Thanks to the wonderful collaboration with Children’s and support from multiple divisions, these babies got off to a good start.”

A total of 50 medical professionals from both the Hospital Center and Children’s were involved in this morning’s delivery. A maternal/fetal team experienced in high-risk deliveries performed the C-section. In an adjoining operating room, two identical teams - each with a pediatric surgeon, neurosurgeon, neonatologist, otolaryngologist, and neonatal nurse - were assigned to each twin following delivery to attend to their immediate medical needs. An additional third team was on standby to support the other two under the supervision of Zacharia Cherian, chair, Neonatology, Washington Hospital Center. Dr. Cherian said teamwork between the Hospital Center and Children’s staff was outstanding. “This was truly a team effort and testament to the medical excellence of both institutions. We were well-planned and well-rehearsed to handle the complex medical care of these babies.”

As soon as the twins were stabilized, a fifth team - the Children’s Transport Team prepared the twins for the three-minute transport from the operating room to a waiting ambulance that whisked them to Children’s NICU. The twins will undergo a series of tests and assessments this week. Robert Keating, MD, chief, Neurosurgery, who is leading the medical care of the twins at Children’s, said, “Every member of the team continuously demonstrated poise and grace today, and no doubt made this transition nearly seamless. The delivery was one step in what will be a lengthy process. Children’s multidisciplinary team is now working to assess and monitor the most appropriate care plan for the boys.”

Related link

Read the Washington Post's coverage of the separation
September 8, 2006
WashingtonPost.com

Read about the press conference following the successful separation surgery
September 7, 2006
CBS News

Listen to lead surgeon Robert Keating, MD, describe the plan for surgery
September 5, 2006
Wisconsin Radio Network

Associated Press Article "Doctors Optimistic about surgery for twins"
September 2, 2006
St. Paul Pioneer Press

Learn more about the Shaw family with WISN's coverage
August 30, 2006
TheMilwaukeeChannel.com

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