Conjoined twins separated by Brazilian, UK surgeons using VR technology

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LONDON — Brazilian twin brothers Arthur and Bernardo Lima received emotional applause, congratulations and tears from medical staff and family members after their latest risky operation.

The boys were separated for the first time, face to face and holding hands, in a hospital bed in Rio de Janeiro after doctors there and nearly 6,000 miles away in London worked together using virtual reality techniques to operate on the joined 3-year-old.

A highly complex medical procedure separated the twins, who hailed from the northern Brazilian village of Roraima and were born craniopagus, meaning they were joined together by fused skulls and entwined brains sharing a vital vein. Only 1 in 60,000 conjoined twins are born at birth, and even fewer are conjoined cranially.

Medical experts declared that surgery to separate the brothers was impossible.

But medical staff from Rio de Janeiro’s Instituto Estadual do Cérebro Paulo Niemeyer worked with London-based surgeon Noor ul Owase Jeelani of Great Ormond Street Hospital to use advanced virtual reality technology to rehearse the painstaking procedure.

This included extensive imaging of the boys’ brains, including CT and MRI scans, as well as an examination of the rest of their bodies. Health care workers, engineers and others compared the data to create 3D and virtual reality models of the twins’ brains so the teams could study their anatomy in more detail.

International teams then spent months preparing for the procedures, according to to the British charity Gemini Untwined, which facilitated the operation and was founded Jeelani, a renowned neurosurgeon of British Kashmir.

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According to the charity, teams of surgeons have carried out a cross-continental “trial operation” using virtual reality. This technology was used for the first time in Brazil. They performed seven operations to completely separate the twins, which involved hours of work and nearly 100 medical staff.

“The separation was the most difficult to date,” Gemini Untwined said in a statement on Monday. “At nearly four years old, Arthur and Bernardo were also the oldest craniopagus twins with fused brains to be separated, which added complications. The optimal age for weaning is between 6 and 12 months of age.

Although the successful surgery was performed in June, the medical teams did not publicize it to focus on the boys’ recovery, Great Ormond Street Hospital spokeswoman Francesca Eaton told The Washington Post on Wednesday.

Children with craniopagus have usually never sat, crawled or walked before and require intensive rehabilitation after surgery. Arthur and Bernardo will be in hospital for six months and hope to celebrate their fourth birthday together soon, Gemini Untwined said, so they can “finally see each other face to face”, along with their parents Adriely and Antonio Lima.

Jeelani, an expert in separating craniopagus twins, called it an “extraordinary achievement.”

“As a parent myself, it is always such a special privilege to be able to improve outcomes for these children and their families,” he said in a statement. “Not only have we provided a new future for the boys and their families, but we have also given the local team the opportunities and confidence to successfully undertake such challenging work in the future.”

Jeelani told British media reported this week that the last operation was carried out “seven weeks ago”, but it will take time to give a full prognosis for the twins’ future, as older children tend to heal more slowly. He said the coronavirus pandemic has also delayed the operation.

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“In some ways, these operations are considered the most difficult of our time, and to do this in virtual reality was literally a man on Mars,” he told the Press Association. Jeelani said the risky surgery was complicated by scar tissue from the boys’ previous surgeries.

He added that the use of virtual reality techniques means surgeons can see anatomy and practice procedures without putting “kids at risk”, which he says is very “reassuring” for medical professionals. “It was amazing to be able to help them on this journey,” he added.

A Brazilian hospital has said it will continue to work with a British charity to treat other rare cases of conjoined twins in South America.

“This is the first operation of this 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 operation went so well and the results have been life-changing for the boys and their families.

Godfrey Kemp

"Bacon fanatic. Social media enthusiast. Music practitioner. Internet scholar. Incurable travel advocate. Wannabe web junkie. Coffeeaholic. Alcohol fanatic."

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