Comment LONDON — After emerging from a final risky surgery, Brazilian twin brothers Arthur and Bernardo Lima were met with an emotional outpouring of applause, cheers and tears from medical staff and family members. For the first time, the boys lay separately, face to face and holding hands in a shared hospital bed in Rio de Janeiro, after doctors there and nearly 6,000 miles away in London collaborated using virtual reality techniques to operate on the 3 united. -years. The highly complicated medical procedure separated the twins, who hail from Roraima in the northern Brazilian province and were born cranio-frozen, meaning they were joined together by fused skulls and entwined brains that shared vital veins. Only 1 in 60,000 births result in conjoined twins, and even fewer are joined cranially. Medical experts had ruled surgery to separate the siblings impossible. But medical staff from Rio Paulo Niemeyer’s Instituto Estadual do Cérebro teamed up with surgeon Noor ul Owase Jeelani from London-based Great Ormond Street Hospital to use advanced virtual reality technology to rehearse the painstaking procedure. It included detailed imaging of the boys’ brains, including CT and MRI scans, as well as checks on the rest of their bodies. Health 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 greater detail. International teams then worked for months to prepare for the operations, according to the British charity Gemini Untwined, which facilitated the surgery and was founded by Jeelani, a renowned British-Kashmiri neurosurgeon. Environmental disasters plague Latin America and the Caribbean, the report says Surgical teams have carried out a cross-continental “trial surgery” using virtual reality, the first time such technology has been used for this purpose in Brazil, according to the charity. They then had seven surgeries to completely separate the twins, involving hours of surgery and nearly 100 medical staff. “The breakup was the hardest to date,” Gemini Untwined said in a statement on Monday. “At nearly four years of age, Arthur and Bernardo were also the oldest brain-fused skull ice twins to be separated, bringing additional complications.” The optimal age for separation is between 6 and 12 months, he said. Although the successful surgery took place in June, the medical teams avoided publicizing it to focus on the boys’ recovery, Francesca Eaton, a spokeswoman for Great Ormond Street Hospital, told The Washington Post on Wednesday. Children with fused skulls 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 are looking forward to celebrating their fourth birthdays soon, Gemini Untwined said, “finally being able to see each other face to face”, along with their parents Adriely and Antonio Lima. Jeelani, an expert in separating fraternal twins, called it a “remarkable achievement”. “As a parent myself, it is always 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 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.” Jelani told British media this week that the final surgery took place “seven weeks ago” but that it would take time for a full prognosis on the twins’ future – as older children tend to heal more slowly. He said the coronavirus pandemic had also delayed the surgery. Up to 1 in 4 known pregnancies may end in miscarriage “In some ways, these operations are considered the most difficult of our time, and doing them in virtual reality was something that was really human on Mars,” he told the Press Association. Jelani 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 surgeons could see the anatomy and practice without putting “children at risk”, which he said was massively “reassuring” to medical specialists. “It was great 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, similar cases of conjoined twins in South America. “This is the first surgery of such 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 surgery went so well and the boys and their family had such a life-changing outcome.”
