This is a ‘man-on-Mars’ story, famed English neurosurgeon Dr Noor Ul Owase Jeelani told the Press Association. “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,” he said.

He was talking about the separation of two Brazilian twins who were joined at the head, using virtual reality and surgical teams in two countries, the UK and Brazil.

They describe the miracle on the website of Gemini Untwined, the British charity established in 2018 by Dr Jeelani that has partnered with some of the world’s most renowned paediatric care facilities to carry out life-saving operations for craniopagus twins.

It also works “to empower medical teams around the world with the skills, knowledge and experience to undertake these highly complex procedures themselves,” and in this case, it has empowered a Brazilian hospital, Instituto Estadual do Cérebro Paulo Niemeyer, with those skills.

Arthur and Bernardo were born craniopagus in a rural area of northern Brazil in 2018. Their parents, Adriely and Antonio Lima, brought the boys to the Instituto in Rio de Janeiro, where they were cared for diligently for two and a half years.

Earlier this year, the Rio hospital contacted Gemini for advice after being told by other experts that surgery to separate the boys was impossible. 

For Gemini, this separation was the most challenging one they have done to date, as the boys shared vital veins in the brain and, at almost four years old, they were also the oldest craniopagus twins with a fused brain to be separated.

Led by Dr. Jeelani, the UK team spent months working with the Rio team to prepare, involving a trial surgery conducted cross-continentally in virtual reality, the first time such technology had been used for this purpose in Brazil. This sharing of expertise between the two medical teams was central to success, Gemini says.

There is an incredibly moving video about the operation on the Gemini website.

The procedures involved nearly 100 medical staff and seven separate surgeries, with over 33 hours operating time in the final two surgeries alone. For the first time, surgeons in separate countries wore headsets and operated in the same “virtual reality room” together.

“As a parent myself, it is always such a special privilege to be able to improve the outcome for these children and their family,” said Dr Jeelani. “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.”

Following the surgery, the Instituto Estadual do Cérebro Paulo Niemeyer will now become a Gemini Global Partner hub, ensuring that in future, similar cases in Latin America receive the same level of world-class care. Dr Gabriel Mufarrej, the Instituto’s head of paediatric surgery, will continue working with Gemini Untwined to share the knowledge that his team has built up.

“This is the first surgery of this complexity in Latin America,” said Dr. Mufarrej. He said the boys had become “part of our family here in the hospital,” following more than two years of care. “We are delighted that the surgery went so well and the boys and their family have had such a life-changing outcome.”

Arthur and Bernardo will have six months of reahabilitation at the hospital. With their fourth birthday approaching, they will be able to celebrate being separate – but together – for the first time, finally able to see each other face to face. 

Gemini Untwined supports the development of innovative technologies which allow surgeons to easily view the anatomy of craniopagus twins from different angles, zoom into details, hide specific structures, and cut into the skull surface, according to its website. “Our aim is to conduct clinical research and innovations that will lead to better understanding of the anatomies of our twins’ brains and safer, more evidence-based surgeries.”

Because craniopagus twins are so rare, research into the epidemiology, natural history and anatomy of this condition is limited. Gemini is collating the knowledge built from its own cases, and wants to collaborate with medical centres and families around the world to help answer key questions, such as how many craniopagi are alive in the world today? How does life bode for them if they remain conjoined or separated? Are there pockets of the world with a higher prevalence?”

“Gemini Untwined is the world’s leading charity dedicated to researching and supporting craniopagus twins and their families through surgical separation. Craniopagus twins are rare, so making a philanthropic donation to Gemini Untwined really is a personal lifeline to a child born with this condition.”