Bernardo and Arthur Lima are not like other twins: they were born conjoined, sharing not only the top of the head and part of the brain, but an important vein that connects to the heart.
Now, a breakthrough surgery, made possible in part by surgeons working together virtually, is expected to have given them a chance at life like any other sibling pair.
The pair underwent surgery shortly before their fourth birthday, making them the oldest twins with a fused brain to have been successfully separated.
For months, surgeons from both England and Brazil collaborated via a virtual reality operating room to carefully map out the best way to separate the twins’ fused brains without impairing function or severing these vital veins.
When it came time to make this work a reality, it took almost 100 medical staff in seven offices.
“Everything went very well,” Dr. Noor ul Owase Jeelani, a pediatric neurosurgeon who led the surgery, said in a video posted by Gemini Untwined. Gemini Untwined is a charity that aims to help craniopagus twins – children who are joined at the head and have fused skulls and brains.
Jeelani is the co-founder of Gemini Untwined, which was established in 2018, coincidentally the same year that Bernardo and Arthur were born in a rural town in northern Brazil.
The two boys were joined at the top of their heads, facing opposite directions. Although conjoined twins are already rare, craniopagus twins make up just five percent of all conjoined twins, meaning they occur once in 1.2 million births.
The twins’ parents, Adriely and Antonio Lima, took them to Rio de Janeiro where a medical team from 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 craniopagus twins die by the age of one.
But after numerous experts said it would be impossible to separate the boys, the hospital contacted Gemini Untwined.
His was a difficult case for several reasons. Not only did they share important veins in their brains, but they were almost four years old. According to the Gemini Untwined website, the ideal age to separate craniopagus twins is between 6 and 12 months.
Doctors scanned the twins’ skulls, brains and soft tissue to create a virtual mirror to study, even performing test surgery across continents virtually.
The surgical team underwent months of preparation using #VR cross-functionally to share knowledge and practice techniques, developing a plan to separate their fused brains. pic.twitter.com/L8va4oJ0JX
— Gemini Untwined (@GUntwined) August 2, 2022
After numerous surgical procedures, the final surgery to separate the boys in Brazil was about 27 grueling hours, filled with countless prayers.
The video posted by Gemini Untwined shows the parents hugging medical staff before the surgery, and then the moment the two boys finally separated. The staff wiped away tears after their success.
“We just finished the twin separation surgery. The surgery went very well. It’s an excellent, excellent team here with Dr. Mufarrej,” Jeelani said in the video, gesturing to Dr. Gabriel Mufarrej, head of pediatric surgery at the Instituto Estadual do Cerebro Paulo Niemeyer, who helped lead the procedure with him.
Another clip shows the twins leaving the surgery room. Applause breaks out and more hugs are exchanged.
It’s not over for the boys. This is just the beginning of six months of rehabilitation in the hospital, and then more intensive rehabilitation. But the medical team is hopeful.
“As a parent, it is always such 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 given the local team the skills and confidence to undertake such a complex job successfully again in the future.”
Mufarrej added in a statement on the Gemini website that this was “the first surgery of this complexity in Latin America,” praising the work of Jeelani and the rest of the team.
“Since the children’s parents came from their home in the Roraima region to Rio to ask for help two and a half years ago, they had become part of our family here at the hospital. We are delighted that the surgery went so well and that the children and their families had such a life-changing outcome.”