How Kashmir-origin doctor separated Brazilian twins fused at the brain

Three-year-old boys Bernardo and Arthur Lima were born with fused brains in Brazil. The operation was conducted by a team of 100 medical experts, engineers and support staff in separate countries wearing virtual reality headsets, led by Kashmiri-origin Dr Noor ul Owase Jeelani from London

The three-year-old twins were separated after 33-hour-long surgery. Gemini Untwined

Famed Kashmiri-origin surgeon Dr Noor ul Owase Jeelani is again in the news for yet another miracle surgery of Brazilian conjoined twins whose brains were fused.

Dr Jeelani, who is known for complicated procedures separating craniopagus twins, led a team of 100 surgeons, engineers and other staffers in the 33-hour-long operation.

The surgery, which was described by Jeelani as “space-age stuff”, was conducted in Rio de Janeiro, with direction from Great Ormond Street Hospital in London, the BBC reported.

The surgery

Three-year-old boys Bernardo and Arthur Lima were born with fused brains in Brazil and were under the constant care of Dr Gabriel Mufarrej, who heads paediatric surgery at Instituto Estadual do Cerebro Paulo Niemeyer for the last more than 30 months, the Independent reported.

Since the twins are almost four years old, they are also the oldest craniopagus twins with a fused brains to have been separated, the report said.

According to Gemini Untwined, a charity that was founded by Jeelani in 2018 for similar cases, it was one of the most complex separation processes ever completed.

For the first time, surgeons in separate countries wore headsets and operated in the same “virtual reality room” together while Jeelani provided guidance from London’s Great Ormond Street Hospital.

As per the BBC, the twins had seven surgeries, involving more than 27 hours of operating time in the final operation alone.

Surgery over virtual reality (VR)

Practicing for months wearing VR headsets and finally achieving the task in the same manner was perhaps one of the most important aspects of this surgery.

The teams spent months trialling techniques using virtual reality projections of the twins, based on CT and MRI scans, the BBC reported.

“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. 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,” Jeelani said.

Both twins are recovering well in hospital and will be supported with six months of rehabilitation, the charity has said.

Jeelani’s previous successful surgeries involving conjoined twins

Dr Jeelani has led five successful operations before separating the Brazil twins. He has previously operated on twins from Pakistan, Sudan, Israel and Turkey.

Unlike earlier cases, the Rio twins had fused brains within the fused skulls, making it the most challenging surgery ever touched by Dr Jeelani and his team.

According to Gemini Untwined, one in 60,000 births results in conjoined twins, and only 5 per cent of these are craniopagus children.

In 2019, Dr Jeelani led an operation to separate two-year-old craniopagus sisters Safa and Marwa Ullah from Charsadda in Pakistan. The team of doctors conducted three major operations to separate their heads at Great Ormond Street Hospital (GOSH).With inputs from agencies

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