The highly complex medical procedure separated the twins, who come 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 results in conjoined twins, and even fewer are cranially joined.
Medical experts had called surgery to separate the brothers impossible.
But medical staff at Rio’s Instituto Estadual do Cérebro Paulo Niemeyer worked with London surgeon Noor ul Owase Jeelani of Great Ormond Street Hospital to use advanced virtual reality technology to rehearse the laborious procedure.
This involved detailed imaging of the boys’ brains, including CT scans and MRIs, as well as checks on the rest of their bodies. Health workers, engineers and others gathered data to create 3D and virtual reality models of the twins’ brains to allow teams to study their anatomy in more detail.
International teams then spent months working to prepare for the procedures, according to the British charity Gemini Untwined, which facilitated the operation and was founded by Jeelani, a renowned Anglo-Kashmiri neurosurgeon.
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Surgical teams conducted intercontinental “trial surgery” using virtual reality, the first time such technology had been used for this purpose in Brazil, according to the charity. They then performed seven surgeries to fully separate the twins, involving hours of surgery and almost 100 medical staff.
“The separation was the most difficult to date,” Gemini Untwined said in a statement Monday. “At almost four years old, Arthur and Bernardo were also the oldest craniopagus twins with a fused brain to separate, which brought additional complications.” The optimal age for separation is between 6 and 12 months, he said.
Although the successful operation took place in June, teams of doctors did not publicize it so they could focus on the boys’ recovery, said Francesca Eaton, spokeswoman for Great Ormond Street Hospital , to the Washington Post on Wednesday.
Craniopagus joint children have usually never sat, crawled, or walked before and require intensive rehabilitation after surgery. Arthur and Bernardo will undergo six months of rehabilitation in hospital and look forward to celebrating their fourth anniversary together soon, said Gemini Untwined, “finally able to see each other face to face”, alongside their parents Adriely and Antonio Lima.
Jeelani, a specialist in the separation of craniopagus twins, called it a “remarkable achievement”.
“As a parent myself, it is always such a special privilege to be able to improve the lot of these children and their families,” he said in a statement. “Not only have we provided a new future for the boys and their families, but we have given the local team the skills and confidence to successfully undertake such complex work again in the future.”
Jeelani Told British media said this week that the last surgery took place “seven weeks ago”, but that it would take time to establish a full prognosis on the future of the twins, as older children tend to be slower to heal. He said the coronavirus pandemic also delayed the operation.
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“In some ways, these operations are considered the most difficult of our time, and doing them in virtual reality was really a man thing on Mars,” he told the Press Association. Jeelani said the risky surgery was complicated by scar tissue from previous operations on the boys.
He added that the use of virtual reality techniques meant that surgeons could see anatomy and perform procedures without putting “children at risk”, which he said was extremely “reassuring” for medical specialists. “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 and similar cases of conjoined twins in South America.
“This is the first surgery of this complexity in Latin America,” said Gabriel Mufarrej, 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 that the boys and their families had such a life-changing result.”
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