Baby Evelyn undergoes surgery in Arkansas

LITTLE ROCK - An 11-hour surgery to remove a neck malformation the size of a second head from a 2-year-old was successful, doctors said.

Evelyn Zagal lay on the operating table at Arkansas Children's Hospital for most of Friday, surrounded by four surgeons, six scissors-like clamps, two flesh-cooking cauterizing utensils and one doctor whose sole job appeared to be to hold the baby's head.

"You can see a huge difference," Dr. Lisa Buckmiller said late Friday after the procedure finished. "It's like night and day. It was immediately gratifying but it has potential for coming back."

During the day, in the chilly waiting room, Evelyn's mother, 21-year-old Teresa, waited nervously, wrapped in a blanket. Her husband, Carlos, 23, and their son Alex distracted themselves with crayons and paper, but Teresa couldn't take her mind off her baby's crucial surgery. The family had traveled to Arkansas from Rockford, Ill., to have the surgeons treat Evelyn's congenital lymphatic malformation.

"I just hope they don't shave her head," Teresa said.

Buckmiller, along with Dr. James Suen, did order the baby's head shaved - the weighty growth was just too all-consuming. They began their incision at the back and worked their way toward the left side of her jaw, the site of the bulk of the lymphatic overgrowth. In the end they removed 75 percent of the mass and much of the extra skin, Buckmiller said.

Suen, the world-renowned head and neck surgeon whose skills have brought the Zagals so far from home, sat on a chair behind the patient. His protegee, Buckmiller, stands for hours on end, leaning over the crowded incission, teaching residents what Suen had taught her.

There isn't too much blood, but there are meandering pockets and channels of diseased tissue and white cysts that the surgical team must delicately separate from critical nerves and ease out of the child's head.

"They wanted us to tease it out," Buckmiller said at the outset. "I don't know how teasy it's going to be. We're way far back and it still seems like we're not making any progress."

But they did. At one point, Evelyn's airway pressure went down as her head had turned and kinked the breathing tube hooked to Evelyn's displaced trachea, but a technician moved in, worked under a sheet and restored the proper levels. Eight hours into the surgery, the doctors reported they were on schedule for a 12-to-18-hour procedure.

"We need to remove it in sections, and (the malformation) is so big, it's hard to keep in tact," Suen said as he dug in for the long afternoon.

Buckmiller said it will take a couple of months for the swelling to go down and doctors will concentrate on allowing Evelyn to swallow and talk.