The highly complex medical procedure separated the twins, who came from Roraima in rural northern Brazil and were born craniopagus, meaning they were connected to each other with fused skulls and intertwined brains that shared vital veins. only 1 in 60,000 births result in conjoined twins, and even fewer are cranially conjoined.
Medical experts declared an operation to separate the brothers impossible.
But medical staff from Rio’s Instituto Estadual do Cérebro Paulo Niemeyer worked with London-based surgeon Noor ul Owase Jeelani from Great Ormond Street Hospital to use advanced virtual reality technology to rehearse the painstaking procedure.
It involved detailed imaging of the boys’ brains, including CT and MRI scans, as well as checks on the rest of their bodies. Healthcare workers, engineers and others collected data to create 3D and virtual reality models of the twins’ brains to allow the teams to study their anatomy in more detail.
International teams then spent months working to prepare for the proceedings. respectively to the British charity Gemini Untwined, which facilitated the operation and was founded by Jeelani, a renowned British-Kashmiri neurosurgeon.
Surgical teams carried out a transcontinental “trial surgery” using virtual reality, the first time such technology had been used for this purpose in Brazil, according to the charity. They went on to perform seven operations to completely separate the twins, involving hours of work and nearly 100 medical personnel.
“The separation was the most challenging yet,” Gemini Untwined said in a statement on Monday. “At almost four years old, Arthur and Bernardo were also the oldest craniopagus twins with a fused brain to be separated, which led to further complications.” The optimal age for separation is between 6 and 12 months, he said.
Although the successful operation took place in June, medical teams delayed publicizing it so they could focus on the boys’ recovery, Francesca Eaton, a spokeswoman for Great Ormond Street Hospital, told The Washington Post on Wednesday.
Siamese children have usually never sat up, crawled or walked before and require intensive rehabilitation after surgery. Arthur and Bernardo will undergo six months of rehabilitation in the hospital and are looking forward to celebrating their fourth birthday together soon, Gemini Untwined said, “finally being able to see each other face to face” with their parents Adrielli and Antonio Lima.
Jelani, a specialist in separating craniopagus twins, called it a “remarkable achievement.”
“As a parent, it is always such a special privilege to be able to improve the outcome for these children and their families,” he said in a statement. “Not only have we secured a new future for the boys and their families, we have equipped the local team with the capabilities and confidence to undertake such complex work successfully again in the future.”
Jelani said British media this week said the latest operation took place “seven weeks” ago, but that it would take time to fully predict the future of the twins – as older children are usually treated more slowly. He said the coronavirus pandemic has also delayed the operation.
“In some ways, these operations are considered the most difficult of our time, and doing them in virtual reality is just like a man on Mars,” he told the Press Association. Jelani said the risky surgery was complicated by a scar from the boys’ previous surgeries.
He added that the use of virtual reality techniques meant surgeons could see anatomy and practice procedures without putting “children at risk”, which he said was massively “reassuring” to medical professionals. “It was wonderful to be able to help them on this journey,” he added.
The Brazilian hospital said it would continue to work with the British charity to treat other rare cases of conjoined twins in South America.
“This is the first operation of this complexity in Latin America,” said Gabriel Moufarray, head of pediatric surgery at the Instituto Estadual do Cérebro Paulo Niemeyer.
He said the boys had become “part of our family here at the hospital” after more than two years of medical care. “We are delighted that the operation went so well and the boys and their families had such a life-changing outcome.”