Very complex medical procedures separated the twins, who came from Roraima in rural northern Brazil, and were born from the craniums, meaning they were joined together by fused skulls and intertwined brains that shared vital veins. Just 1 in 60,000 Births result in conjoined twins, and even less so that join the skull.
Medical experts had described the process of separating the two brothers as impossible.
But medical staff from the Instituto Rio de Cerebro Paulo Niemeyer worked with London-based surgeon Nour Alawas Gilani of Great Ormond Street Hospital to use advanced virtual reality technology to practice the strenuous procedure.
It involved detailed imaging of the boys’ brains, including computerized tomography and magnetic resonance imaging, as well as scans of 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 teams to study their anatomy in more detail.
Then the international teams spent months working to prepare for the proceedings. according to To the British charity Gemini who facilitated the surgery and was was established By Jilani, a famous British Kashmiri Neurosurgeon.
Surgical teams have performed “experimental surgery” across continents using virtual reality, the first time this technology has been used for this purpose in Brazil, according to the charity. They went on to perform seven surgeries to completely separate the twins, which took hours of operating time and about 100 medical personnel.
“The breakup was the most difficult to date,” Gemini Antwinend said in a statement on Monday. “At about age four, Arthur and Bernardo were also the oldest cranial twins with a combined brain to be separated, which led to additional complications.” She added that the optimal age for separation is between 6 and 12 months.
Even though the surgery was successfully performed in June, teams of doctors have delayed posting it so they can focus on the boys’ recovery, Great Ormond Street Hospital spokeswoman Francesca Eaton told the Washington Post Wednesday.
Children with craniosynostosis usually have never sat, crawl or walked before and need extensive rehabilitation after surgery. Arthur and Bernardo will be undergoing six months of rehab in the hospital and are looking forward to celebrating their fourth birthday together soon, as the unfamiliar Gemini said, “we finally got to see each other face to face” alongside their parents Adrielle and Antonio Lima.
Gilani, who specializes in separating craniofacial twins, described it as a “remarkable achievement”.
“As a parent, it is always a special privilege to be able to improve outcomes for these children and their families,” he said in a statement. “Not only did we create a new future for the boys and their families, we also provided the local team with the capabilities and confidence to successfully carry out such complex work again in the future.”
Gilan Tell British media reported this week that the last surgery was performed “seven weeks ago” but it will take time to fully predict the future of twins – as older children tend to have a slower recovery. He said the coronavirus pandemic delayed the surgery.
“In some ways, these are the toughest operations of our time, and doing it in virtual reality was just stuff on Mars,” he told the Press Association. Gilani said the risky surgery was complicated by scars from previous operations on the boys.
He added that the use of virtual reality technologies meant that surgeons could see the anatomy and practice procedures without putting “children at risk”, which he said was hugely “reassuring” for medical professionals. “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 similar rare cases of conjoined twins in South America.
“This is the first surgery for this complication in Latin America,” said Gabriel Mofarge, chief of pediatric surgery at Instituto Estadual do Cérebro Paulo Niemeyer.
He said the boys became “part of our family here in the hospital” after more than two years of Medicare. “We are pleased that the surgery went well and that the boys and their families achieved life-changing results.”
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