A highly complex medical procedure separated the twins from Roraima, northern Brazil, who were born craniopagus, meaning they were connected by fused skulls and fused brains that shared vital vessels. Only 1 in 60,000 births result in conjoined twins and fewer are fused with the skull.
Medical experts had declared surgery to separate the brothers impossible.
But medics at Rio’s Instituto Estadual do Cérebro Paulo Niemeyer, along with surgeon Noor ul Owase Jeelani of London-based Great Ormond Street Hospital, used advanced virtual reality technology to practice the painstaking procedure.
This involved taking detailed images of the boys’ brains, including CT and MRI scans, as well as examining the rest of their bodies. Healthcare professionals, engineers and others combined the data to create 3D and virtual reality models of the twins’ brains, allowing the teams to study their anatomy in greater detail.
International teams then worked for months to prepare for the procedures. according to British charity Gemini Untwined, which facilitated the operation and became established By the famous British-Kashmiri neurosurgeon Jeelani.
According to the charity, surgical teams have carried out cross-continental “trial surgery” using virtual reality, the first time such technology has been used for this purpose in Brazil. They went on to perform seven operations involving hours of labor and nearly 100 medical staff to fully separate the twins.
“The breakup was the hardest to date,” Gemini Untwined said in a statement on Monday. “At almost four years old, Arthur and Bernardo were also the oldest craniopaque twins with fused brains who separated, bringing additional complications.” The optimal age for separation is said to be 6 to 12 months.
Francesca Eaton, a spokeswoman for Great Ormond Street Hospital, told The Washington Post on Tuesday that although the successful operation took place in June, medical teams refrained from publicizing it to focus on the boys’ recovery.
Children with craniopagus fusion usually have never sat, crawled or walked before and require intensive rehabilitation after surgery. Arthur and Bernardo will undergo six months of rehab in the hospital and are looking forward to celebrating their fourth birthday together soon, Twins Untwined said, along with their parents Adriely and Antonio Lima, who “can finally see each other face to face.”
Jeelani, an expert on craniopagus twin separation, called it a “wonderful achievement”.
“As a parent, it’s always a special privilege for me to be able to improve outcomes for these children and their families,” she said. “Not only have we secured a new future for the boys and their families, we have equipped the local team with the capacity and confidence to successfully carry out such a complex task again in the future.”
Jeelani he said British media this week said the latest surgery was “seven weeks ago” but a full prognosis on the twins’ future will take time because older children are slower to recover. I said that the coronavirus pandemic also delayed the operation.
“In some ways, these operations are considered the most difficult of our time, and doing it in virtual reality was just a human thing on Mars,” he said. Jeelani said the risky surgery was complicated by scar tissue from previous surgeries on the boys.
He added that the use of virtual reality techniques means surgeons can see anatomy and practical procedures “without putting children at risk”, which is massively “reassuring” for medical professionals. “It was great to help them along the way,” he said.
The Brazilian hospital said it would continue to work with a British charity to treat other rare, identical twins in South America.
“This is the first operation of this complexity in Latin America,” said Gabriel Mufarrej, head of pediatric surgery at the Instituto Estadual do Cérebro Paulo Niemeyer.
After more than two years of medical care, the boys have “become part of our family here at the hospital,” he said. “We are delighted that the operation went so well and that the boys and their family had such a life-changing outcome.”
