Bernardo and Arthur Lima aren’t like other twins — they were born conjoined, sharing not only the top of their heads and part of the brain, but a major vein that connects to the heart.

Now, a breakthrough surgery, made possible in part by surgeons working together virtually, has hopefully given the boys a chance at life like any other pair of brothers.

The pair were operated on shortly before their fourth birthday, making them the oldest twins with a fused brain to have been successfully separated.

For months, surgeons in both England and Brazil collaborated through a virtual reality operating theatre in order to painstakingly map out how best to separate the twins’ fused brains without impairing function or severing those vital veins.

When it came time to make that work a reality, it took almost 100 medical staff across seven surgeries.

“It’s all gone really well,” Dr. Noor ul Owase Jeelani, a paediatric neurosurgeon who led the surgery, said in a video posted by Gemini Untwined. Gemini Untwined is a charity that seeks to help craniopagus twins — children who are joined at the head and have fused skulls and brains.

Jeelani is a co-founder of Gemini Untwined, which was established in 2018, coincidentally the same year that Bernardo and Arthur were born in a rural town in Northern Brazil.

The two boys were joined at the top of the head, facing in the opposite direction of each other. While conjoined twins are already rare, craniopagus twins make up just five per cent of all conjoined twins, meaning that they occur once in 1.2 million births.

The twins’ parents, Adriely and Antonio Lima, brought them to Rio de Janeiro where a medical team at the Instituto Estadual do Cerebro Paulo Niemeyer took care of the twins for two and a half years.

The boys had already defied that odds — around 78 per cent of craniopagus twins die by the age of one.

But after numerous experts said that it would impossible to separate the boys, the hospital reached out to Gemini Untwined.

Theirs was a difficult case for a number of reasons. Not only did they share important veins in the brain, but they were nearly four years old. According to Gemini Untwined’s website, the ideal age to separate craniopagus twins is between 6-12 months old.

Doctors scanned the twins’ skulls, brains and soft tissue in order to create a virtual mirror to study, even performing a trial surgery across continents virtually.

After numerous surgical procedures, the final surgery to separate the boys in Brazil was a gruelling 27 hours, filled with countless prayers.

The video posted by Gemini Untwined shows the parents embracing medical staff prior to the surgery, and then the moment when the two boys were finally separated. Staff wiped away tears in the aftermath of their success.

“We have just finished the twin separation surgery. The surgery has gone really well. It’s an excellent, excellent team here with Dr. Mufarrej,” Jeelani said in the video, gesturing to Dr. Gabriel Mufarrej, head of paediatric surgery at Instituto Estadual do Cerebro Paulo Niemeyer, who helped lead the procedure with him.

Another clip shows the twins being wheeled out of the surgery room. Applause breaks out, and more hugs are exchanged.

It’s not over for the boys. This is just the start of six months of rehabilitation at the hospital, and more intense rehab after that. But the medical team is hopeful.

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

Mufarrej added in a statement on Gemini’s website that this was “the first surgery of this complexity in Latin America,” praising the work of Jeelani and the rest of the team.

“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.”