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Still Doing His Homework

Binghamton grad makes surgical history through good old-fashioned research.

Carl and Clarence Aguirre were a one-in-10 million birth. The Filipino twins were conjoined at the head — a condition known as craniopagus twins — the rarest form of a rare birth defect that almost never turns out well.

Nearly 80 percent of craniopagus twins die before their second year, and even when a daring surgical separation is attempted, in the past at least half have died, and of those that survive, almost none has emerged with full brain function.

The dismal statistics surrounding craniopagus separations weren’t lost on David Staffenberg ’85, MD, a plastic surgeon specializing in craniofacial surgery at the Children’s Hospital at Montefiore in New York City, who took on the Aguirre twins as patients in 2002. Even though the procedure would be a first for Staffenberg, he had a distinct advantage over older, more experienced surgeons: his tremendous creativity and a talent for research.

Staffenberg spent two years of his medical training doing nothing but research, an unusual educational path for a surgeon. With that experience, he learned how to approach intractable problems from fresh angles, something that proved to be the key to success with the Aguirre twins.

In the past, when doctors attempted a craniopagus separation, they engaged in a marathon surgical session — 60 or 70 hours straight — that caused tremendous strain on both patient and surgeon and seldom produced positive results.

Staffenberg did extensive case-by-case research, contacting colleagues around the world to figure out why the marathon method had failed. He spent countless hours with the Aguirre twins and their mother, learning everything there was to know about the boys’ health and strength.

Eventually, Staffenberg and his co-surgeon, Dr. James Goodrich, developed a new technique that built on other surgical teams’ experiences. Instead of performing the daunting surgery in one burst or breaking it up into a series of smaller surgeries days apart — as others had done with some success — the twins would be separated over the course of 10 months.

Between each surgery — and there would be many — the twins would have weeks or months to recover physically and mentally from the trauma of the previous surgery and doctors would have time to assess exactly what needed to happen in the next stage.

The separated and healthy Aguirre twins celebrated their sixth birthday in April 2008, with all signs pointing to completely normal brain development and function. Staffenberg and Goodrich’s staged method has been adopted as the worldwide standard for craniopagus separations and other complex craniofacial reconstructions.
In 2005, Staffenberg delivered the commencement address at the College of Mount Saint Vincent and was awarded an honorary degree. Staffenberg consulted on another set of craniopagus twins in Europe that was also successfully separated using the staged technique, and was invited to speak at the Royal Society of Medicine in London on the philosophy and physiology that led to the development of this technique.

Learn more about research at Binghamton and the incredible work of Staffenberg and his colleagues at the Children’s Hospital at Montefiore.

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Last Updated: 10/14/08