Inside the Children’s Hospital at Montefiore Medical Center, the press, various guests, and hospital associates eagerly awaited the arrival of formerly conjoined twins Carl and Clarence Aguirre. That Friday, April 20, the boys celebrated their fifth birthday, almost two and a half years since the unprecedented surgery that successfully separated them.

When they finally appeared wearing matching blue helmets, the twins looked sleepy, still waking up from their afternoon nap. After everyone sang “Happy Birthday,” Arlene Aguirre helped her sons blow out the candles on two birthday cakes – one for each of her two healthy boys.

“I am very happy to share that my boys are five years old and I’m still pinching myself, asking if it’s real,” said the cheerful mom.

When Aguirre arrived in New York City with her sons in September of 2003, the fate of her twins was uncertain at best.

Once craniopagus twins, the boys were joined at the top of their heads and shared a two-inch section of brain tissue as well as skull bone and vital blood vessels. Their condition inhibited digestion, caused respiratory infections, and was causing the boys to slowly die. But thanks to the surgical care and treatment the boys received at The Children’s Hospital, Clarence and Carl are on the road to normal childhoods, Aguirre said.

“No such twins in history have lived to the age of five, much less continued to develop physically, emotionally and intellectually as Clarence and Carl have,” said Dr. James Goodrich, director of pediatric neurosurgery at the Children’s Hospital. Goodrich and chief of pediatric plastic surgery, Dr. David Staffenberg, headed the medical team that separated the twins in a four-stage, 10-month-long procedure.

Since the surgeries, “the twins have retained their distinctly individual personalities,” said Goodrich. “Clarence is still a ham. He runs around like a bandito. Carl was always the shy one and holds back more.” Appropriately enough, at the birthday ceremony, Carl could be seen quietly playing a video game, while Clarence posed for the cameras.

The blue helmets remain a reminder of the boy’s medical history. As a protective measure, the boys must wear the helmets to shield their sensitive skulls, which may be harmed during normal play.

“We have not performed surgery to complete cranial reconstruction of their skulls because we do not want to interrupt their developmental gains with additional hospital stays,” Staffenberg said. The medical team opted to let the boys’ bone to continue to grow on its own, before more reconstructive procedures.

Until then, the boys continue to play and fight like normal 5-year-olds, said Aguirre. This fall, Carl and Clarence will begin their first year of school as kindergartners.