Now, a revolutionary surgery, made possible in part by surgeons working together virtually, has hopefully given the boys a chance at life like any other pair of siblings. The pair underwent surgery just before their fourth birthdays, making them the oldest conjoined brain twins to be successfully separated. For months, surgeons in both England and Brazil collaborated via a virtual reality operating room to painstakingly map out the best way to separate the twins’ fused brains without affecting function or cutting those vital veins. When it came time to make this project a reality, it took nearly 100 medical staff for seven surgeries. “Everything went very well,” said Dr. Noor ul Owase Jeelani, a pediatric neurosurgeon who led the surgery, in a video posted by Gemini Untwined. Gemini Untwined is a charity that seeks to help cranial twins – children who are conjoined at the head and have fused skulls and brains. Jeelani is the co-founder of Gemini Untwined, which was founded in 2018, coincidentally the same year Bernardo and Arthur were born in a rural town in Northern Brazil. The two boys joined at the top of the head, facing each other. While conjoined twins are already rare, fraternal twins make up just 5 percent of all conjoined twins, meaning they occur once in 1.2 million births. The twins’ parents, Adriely and Antonio Lima, brought them to Rio de Janeiro, where a medical team at the Instituto Estadual do Cerebro Paulo Niemeyer cared for the twins for two and a half years. The boys had already defied those odds—about 78 percent of cranial-frozen twins die by age one. But after many experts said it would be impossible to separate the boys, the hospital approached Gemini Untwined. Theirs was a difficult case for several reasons. Not only did they have significant veins in the brain, but they were almost four years old. According to the Gemini Untwined website, the ideal age to separate conjoined twins is between 6-12 months. Doctors scanned the twins’ skulls, brains and soft tissues to create a virtual mirror for study, even performing a test surgery on all continents virtually.
The surgical team underwent months of preparation using #VR cross-continentally to share expertise and practice techniques, developing a plan to separate their fused brain. pic.twitter.com/L8va4oJ0JX — Gemini Untwined (@GUntwined) August 2, 2022 After numerous surgeries, the final surgery to separate the boys in Brazil was a grueling 27 hours filled with countless prayers. The video posted by Gemini Untwined shows the parents hugging the medical staff before the operation and then the moment the two boys were finally separated. The staff wiped away tears after their success. “We just completed the surgery to separate the twins. The surgery went very well. It’s a great, great team here with Dr. Mufarrej,” Jeelani said in the video, gesturing to Dr. Gabriel Mufarrej, chief of pediatric surgery at Instituto Estadual do Cerebro Paulo Niemeyer, who helped lead the process with him. Another clip shows the twins being wheeled out of surgery. Applause breaks out and more hugs are exchanged. It’s not over for the boys. This is just the beginning of six months of recovery in the hospital and more intense recovery after that. But the medical team is optimistic. “As a parent myself, it is always a special privilege to be able to improve the outcome for these children and their families,” Jeelani said in a statement. “Not only have we provided a new future for the boys and their family, but we have equipped the local team with the skills and confidence to successfully undertake such complex work again in the future.” Mufarrej added in a statement on Gemini’s website that this was “the first surgery of such complexity in Latin America,” praising the work of Jeelani and the rest of the team. “Since the boys’ parents came from their home in the Roraima district of Rio to ask for our help two and a half years ago, they have become part of our family here at the hospital. We are delighted that the surgery went so well and the boys and their family had such a life-changing outcome.”
