The extremely complex medical procedure separated twins from Roraima in rural northern Brazil who were born craniopagus, meaning they were connected by fused skulls and intertwined brains that shared vital veins. Just 1 in 60,000 births result in conjoined twins, and even fewer are cranially joined.
Medical experts had stated that surgery to separate the siblings was impossible.
But medical staff from the Instituto Estadual do Cérebro Paulo Niemeyer in Rio worked with London-based surgeon Noor ul Owase Jeelani to use advanced virtual reality technology to rehearse the painstaking procedure.
It involved detailed imaging of the men’s brains, including CT and MRI scans, as well as checking the rest of their bodies. Healthcare workers, engineers, and others blended the data to create 3D and virtual reality models of the twins’ brains to allow teams to further examine their anatomy.
International teams then spent months preparing for the procedures. according to this To the British charity Gemini Untwined, who facilitated the surgery and established By Jeelani, a renowned British-Kashmiri neurosurgeon.
Surgical teams performed an intercontinental “trial surgery” using virtual reality, the first time such technology has been used for this purpose in Brazil, according to the charity. They performed seven surgeries involving hours of work and nearly 100 medical personnel to completely separate the twins.
“The breakup was the most challenging to date,” Gemini Untwined said on Monday. Said. “At almost four years old, Arthur and Bernardo were also the oldest craniopagus twins to be brain-separated, which brought additional complications.” “The best age to leave is between 6 and 12 months,” he said.
Great Ormond Street Hospital spokeswoman Francesca Eaton told the Washington Post on Wednesday that although the successful surgery took place in June, doctors’ teams stopped announcing it so they could focus on the children’s recovery.
Craniopagus-attached children typically have never sat, crawled or walked before and need intensive rehabilitation after surgery. Arthur and Bernardo will go through six months of rehabilitation at the hospital and will soon be looking forward to celebrating their fourth birthday, Gemini Untwined said, along with her parents Adriely and Antonio Lima, who were “finally able to meet face-to-face.”
Jeelani, who specializes in separating craniopagus twins, described it as an “extraordinary achievement”.
“As a parent, it is always a very special privilege to be able to improve outcomes for these children and their families,” she said. “We have not only provided a new future for children and their families, we have equipped the local team with the skills and confidence to successfully undertake such complex tasks in the future.”
Jeelani said British media said this week that the last surgery happened “seven weeks ago”, but a full prognosis for the twins’ future will take time – as older children tend to be slower to recover. He said the coronavirus pandemic also delayed the surgery.
“In some ways, these operations are considered the most difficult of our time, and doing it in virtual reality was truly human work on Mars,” he told the Press Association. Jeelani said the risky surgery was complicated by scar tissue left over from previous surgeries on the men.
He said using virtual reality techniques means surgeons can see anatomy and performing procedures “without putting children at risk,” which is largely “reassuring” for medical professionals. “It was great to be able to help them on this journey,” he added.
The Brazilian hospital said it will 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 this complexity in Latin America,” said Gabriel Mufarrej, head of pediatric surgery at the Instituto Estadual do Cérebro Paulo Niemeyer.
He said the children had become “part of our family in the hospital” after more than two years of medical care. “We are delighted that the surgery went so well and that it had such a life-changing outcome for the children and their families.”
