A pair of Brazilian twins who were conjoined at the head have been successfully separated by a UK-based surgeon.
Three-year-old boys Bernardo and Arthur Lima were born with fused brains and underwent multiple surgeries in Rio de Janeiro under the direction of Great Ormond Street Hospital paediatric surgeon Noor ul Owase Jeelani.
The boys have had seven surgeries, involving more than 33 hours under the knife in the final two alone and almost 100 medical staff.
The procedures were led by Mr Jeelani, alongside Dr Gabriel Mufarrej, the head of surgery at Instituto Estadual do Cerebro Paulo Niemeyer. Surgeons spent months trialling techniques using virtual reality before beginning the real procedures on the boys.
Mr Jeelani described the operation as a “remarkable achievement” by medics following the success.
He said: “The successful separation of Bernardo and Arthur is a remarkable achievement by the team in Rio and a fantastic example of why the work of Gemini Untwined is so valuable.
“Not only have we provided a new future for the boys and their family, we have equipped the local team with the capabilities and confidence to undertake such complex work successfully again in the future.
“It is through this process of teamwork and knowledge-sharing globally that we can hope to improve the outcome for all children and families that find themselves in this difficult position.
“This is only possible through generous donations from members of the public.”
Mr Mufarrej said the hospital where he works had been caring for the boys for two and a half years, and their surgery will be “life-changing”. He said: “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.
“We are delighted that the surgery went so well and the boys and their family have had such a life-changing outcome.”
Their work was supported by Gemini Untwined, a charity founded by Mr Jaleeni to raise funds for siblings born joined at the head – called craniopagus twins.
Separating Bernardo and Arthur from one another was one of the most complex separation processes ever completed, and many surgeons did not think it possible, according to the charity.
Since the twins are almost four years old, they are also the oldest craniopagus twins with a fused brain to have been separated.
Both twins are recovering well in hospital and will be supported with six months of rehabilitation, the charity has said.
According to Gemini figures, one in 60,000 births results in conjoined twins, and only 5 per cent of these are craniopagus children.
In 2019, two-year-old craniopagus sisters Safa and Marwa Ullah, from Charsadda in Pakistan, underwent three major operations to separate their heads at Great Ormond Street Hospital (GOSH), also led by Mr Jeelani.
In order to ensure the operations went smoothly, experts used virtual reality to create exact replicas of the girls’ anatomies and 3D printing to create plastic models of the structures that could be used for practice.
During the surgery, doctors first worked to separate the girls’ blood vessels and then inserted a piece of plastic into their heads to keep the brains and blood vessels apart. Scans had shown that the girls have two distinct brains but these are misshapen, which the plastic and an accompanying pulley system helped to correct.