3-Year-Old Conjoined Twins With Fused Brains Separated in Historic Virtual Reality Surgery

To give birth to conjoined twins is an extremely rare occurrence – 1 in 60,000, in fact. Of those births that are conjoined twins, only five percent of them are what’s known as craniopagus twins. These are twins who are joined at the skull who have intertwined brains and shared blood vessels. It is extremely difficult to separate them. However, in a historic virtual reality surgery, a London-based surgeon did just that. (1)

Historic Virtual Reality Surgery Successfully Separates Cranially Conjoined Twins

Three-year-olds Arthur and Bernardo Lima from Brazil were born as conjoined twins. Not just any conjoined twins, but craniopagus twins. Joined by the tops of their skulls, their brains were intertwined and they shared many blood vessels. Hopes of them being separated were slim. (2)

That is until the charity organization Gemini Untwined got involved. Gemini Untwined is an organization dedicated to providing hope for twins conjoined at the skull. Their goal is to provide craniopagus children and children with complex craniofacial conditions with support and solutions. Since their foundation in 2018, they have successfully separated six sets of craniopagus twins.

Conjoined Twins With Fused Brains Separated by U.K. Surgeon in ‘LIfe-Saving’ Treatment Brazilian twins who were joined at the head have been successfully separated with the help of a British neurosurgeon
Image Credit: Gemini Untwined

Arthur and Bernardo

Arthur and Bernardo Lima are now officially the oldest craniopagus conjoined twins to be separated. The procedure involved hundreds of hours of practice and training for the doctors and medical staff who treated them. Their final two surgeries took a total of 33 hours and over 100 medical staff attended to the pair. 

previously conjoined twins after surgery
Image Credit: Gemini Untwined

The medical professionals involved spent months ahead of time mastering the procedure via a virtual reality training program. Surgeons from separate countries worked together in virtual reality rooms. This was the first time this has ever happened. Thanks to their hard work and endless hours of studying and practice, the surgery was successful

“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,” said pediatric surgeon Noor ul Owase Jeelani who directed the surgeries.

The Most Difficult Surgeries of Our Time

Dr. Jeelani said that these surgeries are extraordinarily complex and in many ways are some of the most difficult of our time. Thanks to modern technology and advanced medical science, they have been successful. One of the things that makes Arthur and Bernardo’s surgery so remarkable is that Jeelani, based in London, directed and trained the surgeons and medical staff at the hospital in Rio. When the time came, he then flew to Rio to perform the operations. It was a global knowledge-sharing experience which now means that the doctors and medical staff in Rio are able to perform this procedure, too. This will ultimately improve outcomes for children and families in Brazil in the future.

“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,” Jeelani said in a statement. “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.”


The surgeries themselves were long and grueling. The final surgery took 27 hours and Dr. Jeelani took only four 15-minute breaks throughout to eat and use the bathroom. Jeelani was, understandably, completely wiped out after the long surgery. Seeing the hugging and tears of joy of the family, however, made it all worth it. 

Twins have an extremely powerful bond, one that many people don’t quite understand. Conjoined twins, particularly, are, well, connected. The boys had to be kept apart and monitored separately after the final surgery. Each boy’s blood pressure and heart rate were extremely high after the procedure. Four days later, however, they were reunited. When they first touched hands, both heart rate and blood pressure immediately came down. Now, with the support of Gemini Untwined, they begin six months of rehabilitation. (3)

We wish all the best to Arthur, Bernardo, and their family as they navigate life with new freedom and hope for their futures, individually and together.

Keep Reading: Emilia Clarke ‘Missing’ Parts of Her Brain After Suffering Two Aneurysm Filming Game of Thrones

1. Gemini Untwined
2. “3-Year-Old Conjoined Twins with Fused Brains Separated in Historic Virtual Reality Surgery.” People. Tommy McArdle. August 1, 2022.
3. “London doctors successfully separates Brazilian conjoined twins in rare procedure.” Standard. Laura Parnaby. August 1, 2022.