Bernardo and Arthur Lima are not like other twins – they were born conjoined, sharing not only the top of their heads and part of their brain, but also a large vein that connects to the heart.
Now a groundbreaking operation, made possible in part by the virtual collaboration of surgeons, has hopefully given the boys a chance at life like any other pair of brothers.
The two underwent surgery shortly before their fourth birthdays, making them the oldest conjoined twins to have been successfully separated.
For months, surgeons in England and Brazil collaborated via a virtual reality operating room to painstakingly map out how best to separate the twins’ fused brains without disrupting function or severing those vital veins.
When it came time to make this work a reality, almost 100 medical staff were needed in seven offices.
“Everything went very well,” said Dr. Noor ul Owase Jeelani, a pediatric neurosurgeon who led the operation, in a video posted by Gemini Untwined. Gemini Untwined is a charity that aims to help craniopagus twins – children who are conjoined at the head and have fused skulls and brains.
Jeelani co-founded Gemini Untwined, which was established in 2018, coincidentally the same year Bernardo and Arthur were born in a provincial town in northern Brazil.
The two boys were joined at the top of the head, facing in the opposite direction of each other. While conjoined twins are now rare, craniopagus make up only five percent of all conjoined twins, meaning they occur once in 1.2 million births.
The twins’ parents, Adrieli and Antonio Lima, brought 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.
Boys have already defied those odds—about 78 percent of craniopagus twins die by age one.
But after many experts said it was impossible for the boys to be separated, the hospital reached out to Gemini Untwined.
Their case was difficult for a number of reasons. Not only did they share important brain veins, but they were almost four years old. According to the Gemini Untwined website, the ideal age to separate craniopagus twins is between 6-12 months.
Doctors scanned the twins’ skulls, brains and soft tissue to create a virtual mirror to study, even performing virtual trial surgery on continents.
The surgical team underwent months of preparation, using #VR across continents to share experiences and practice techniques, developing a plan to separate their fused brains. pic.twitter.com/L8va4oJ0JX
— Gemini Untwined (@GUntwined) August 2, 2022
After multiple surgical procedures, the final operation 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 medical staff before the operation and then the moment the two boys are finally separated. The staff wiped away tears after their success.
“We just finished the operation to separate the twins. The operation went very well. This is an excellent, excellent 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 procedure with him.
Another clip shows the twins being taken out of the operating 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 more intensive rehabilitation after that. 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,” Jelani said in a statement. “Not only have we secured a new future for the boys and their families, we have equipped the local team with the capabilities and confidence to undertake such complex work successfully again in the future.”
Mufarrej added in a statement on Gemini’s website that it was “the first operation of this 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 area of Rio to seek our help two and a half years ago, they have become part of our family here at the hospital. We are delighted that the operation went so well and that the boys and their family had such a life-changing outcome.”
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