Brazilian twins Bernardo (left) and Arthur Lima who have successfully separated.

Virtual reality helps separate conjoined twins with fused brains

Image credit: PA Picture Desk / Gemini Untwined

Surgeons in separate countries have used virtual reality headsets to work together to successfully separate Brazilian twins who were born joined at the head.

Three-year-olds Bernardo and Arthur Lima have been separated after undergoing seven surgical procedures over 27 hours of operating time, involving over 100 medical staff. 

To achieve this feat, surgeons in London and Rio de Janeiro leveraged virtual reality (VR) projections of the twins based on CT and MRI scans. The procedures then took place in Brazil, with the direction of Great Ormond Street Hospital paediatric surgeon Noor ul Owase Jeelani, who participated in the surgery from the UK via virtual reality.

The separation was "one of the most complex separation processes ever completed", according to the charity Jeelani founded in 2018, Gemini Untwined, which funded the procedure. He described the use of VR as “space-age stuff”. 

 Noor ul Owase Jeelani with Bernardo (left) and Arthur, and parents Adriely and Antonia Lima.

Noor ul Owase Jeelani with Bernardo (left) and Arthur, and parents Adriely and Antonia Lima. / Gemini Untwined

Image credit: PA Picture Desk / Gemini Untwined

The surgeon said that, for the first time in the world, surgeons in separate countries wore headsets and operated in the same “virtual reality room” together.

“It’s just wonderful, it’s really great to see the anatomy and do the surgery before you actually put the children at any risk," Jeelani told the PA news agency. "You can imagine how reassuring that is for the surgeons.

“In some ways these operations are considered the hardest of our time and to do it in virtual reality was just really man-on-Mars stuff”.

Doctors had attempted to separate Bernardo and Arthur in the past, unsuccessfully. However, these previous attempts meant their anatomy was complicated by scar tissue, making the procedure extremely risky. At almost four years old, Bernardo and Arthur are the oldest craniopagus twins with a fused brain to have been separated. 

The 27-hour operation was successful and the twins and their families are now recovering well, the surgeon reported. The surgery marks Jeelani's sixth separation procedure with Gemini Untwined, after previously operating on twins from Pakistan, Sudan, Israel and Turkey.

He added that, as with all conjoined twins after separation, the boys’ blood pressures and heart rates were “through the roof”, until they were reunited four days later and touched hands.

Brazilian twins Bernardo (top) and Arthur Lima before being separated

Brazilian twins Bernardo (top) and Arthur Lima before being separated / Gemini Untwined

Image credit: PA Picture Desk / Gemini Untwined

The hospital where the surgery took place had first met the twins two years earlier. One of their doctors, Dr Gabriel Mufarrej, head of paediatric surgery at Instituto Estadual do Cerebro Paulo Niemeyer, reflected on the procedure and the family's journey. 

“Since the parents of the boys came from their home in the Roraima region to Rio to seek our help two-and-a-half years ago, they had become part of our family here in the hospital," he said. “We are delighted that the surgery went so well and the boys and their family have had such a life-changing outcome.”

Due to the success of the surgery, Gemini Untwined is now hoping that it can become a model for a “global health service” providing expert care for other rare diseases.

“The idea behind the charity was to create a global health service for super-rare cases to try and improve results for these kids,” Jeelani said. “The model of what we have done, I think, can and should be replicated for other super-rare conditions.”

The charity estimates that only one in 60,000 births result in conjoined twins and only 5 per cent of these are joined at the head. Every year, 50 such pairs of twins are born, with only 15 surviving beyond the first 30 days of life.

With current technologies such as VR, approximately half of these cases could access this "life-changing" surgical separation.

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