A highly complicated medical procedure separated the twins, who came from Roraima in rural northern Brazil, and were born craniopagus, meaning they had conjoined skulls and brains that shared vital veins. only 1 in 60,000 Birth results in conjoined twins, and even fewer are cranially joined.
Medical experts called surgery to separate the brothers impossible.
But medical staff at Rio’s Instituto Estadual do Cerebro Paulo Niemeyer worked with Noor ul Wasse Jilani, a London-based surgeon at Great Ormond Street Hospital, to use advanced virtual reality technology to rehearse the painstaking procedure.
It involves detailed imaging of the boys’ brains, including CT and MRI scans, as well as checks of the rest of their bodies. Health workers, engineers and others combined the 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 worked for months to prepare for the procedure, accordingly British charity Gemini Untwined, which facilitated the surgery and was established Jilani, a renowned British-Kashmiri neurosurgeon.
Surgical teams conducted a cross-continental “trial surgery” using virtual reality, according to the charity, the first time such technology has been used for this purpose in Brazil. They went on to perform seven surgeries to separate the twins completely, involving operating hours and about 100 medical staff.
In a statement on Monday, Gemini Untwined said, “The separation was the most challenging ever. “At around four years of age, Arthur and Bernardo were also the oldest craniopagus twins to have a fused brain separated, which brings additional complications.” The best age for separation is between 6 and 12 months, it says.
Although the successful surgery took place in June, the team of doctors stopped publicizing it so they could focus on the boys’ recovery, Great Ormond Street Hospital spokeswoman Francesca Eaton told The Washington Post on Wednesday.
Children with craniopagus usually never sit up, crawl or walk before and require intensive rehabilitation after surgery. Arthur and Bernardo will undergo six months of rehabilitation in the hospital and look forward to celebrating their fourth birthday together soon, Gemini Untwind said, “finally being able to see each other face to face,” with their parents Adrily and Antonio Lima.
Jilani, an expert on separating craniopagus twins, called it a “remarkable achievement”.
“As a parent, it is always a privilege to be able to improve outcomes for these children and their families,” she said in a statement. “Not only have we provided 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 complex tasks again in the future.”
Jilani to say British media reported this week that the final surgery took place “seven weeks ago” but it will take time to fully predict the future of the twins – as older babies tend to heal more slowly. He said the coronavirus pandemic has also delayed the surgery.
“In some ways, these operations are considered the most difficult of our time, and doing it in virtual reality was really man-on-Mars stuff,” he told the Press Association. Jilani said the risky surgery was complicated by scar tissue from the boys’ previous operations.
He added that using virtual reality techniques meant surgeons could see anatomy and practice procedures without “putting babies at risk”, which he said was hugely “reassuring” for medical professionals. “It was wonderful 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, similar cases of conjoined twins in South America.
“The first surgery of this complication in Latin America,” said Gabriel Mufarez, head of pediatric surgery at the Instituto Estadual do Cerebro Paulo Niemeyer.
After more than two years of treatment, the boys have become “part of our family here at the hospital,” he said. “We are delighted that the surgery went so well and that the boys and their families have had such a life-changing outcome.”