Oldest craniopagus conjoined twins to be separated

The oldest craniopagus twins (i.e., twins joined at the head with a fused brain) to be separated were Arthur and Bernardo Lima (Brazil, b. 29 August 2018), who underwent surgery to be separated on 8–9 June 2022, aged 3 years 284 days. The series of procedures took place over 27 hours at the Instituto Estadual do Cerebro Paulo Niemeyer in Rio de Janeiro, Brazil; almost 100 medical staff were involved, overseen by paediatric neurosurgeon Professor Noor ul Owase Jeelani and Dr Gabriel Mufarrej.

Conjoined twins are rare, occurring in approximately one in 60,000 births. Craniopagus is the least common type, accounting for just 2-5% of cases.

The extremely complex procedure made use of virtual-reality technology which enabled the surgeons (based in the UK and Brazil) to practise the operation for months in advance using detailed scans of the twins’ heads. The innovative operation was funded by the charity Gemini Untwined, which was founded by Dr Jeelani in 2018.

The first successful craniopagus separation took place on 6 July 1989, separating Vilija and Vitalija Tamulevicius (Lithuania, b. 30 July 1987), aged 1 year 341 days. The procedure began in Moscow, Russia, where Dr Alexander Konovalov (Russia) separated the girls. However, when their bodies rejected their new artificial skulls, they were urgently taken to Dallas, Texas, USA, where Dr Kenneth E Salyer rebuilt them. Previous to this, every head separation had resulted in either brain damage or death to at least one of the twins; the Tamulevicius sisters returned to Lithuania with no brain damage.