Virtual Reality Assisted in a Recent Risky Brazilian Surgery to Permanently Separate Twin Boys Conjoined at the Head

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Recently, Brazilian twin brothers Bernardo and Arthur Lima were conjoined at the head. The 3-year-olds were "the oldest craniopagus twins with a fused brain to be separated." Doctors had indicated that "the optimal age for separation is between 6 and 12 months old." [i]
Conjoined twins.Heritage Daily

Despite this, the parents decided an attempt to separate the twins was for the best. When conjoined in this way, it is known as being craniopagus conjoined. Children who face this hurdle usually cannot sit up, crawl, or walk, until post-surgery rehabilitation occurs. Both boys will undergo six months of rehabilitation following the surgery. [ii]

Before the actual procedure, a "trial surgery" was conducted using virtual reality. Because the twins also share parts of the brain and the main vein carrying blood to the heart, doctors feared there would be serious complications. This was the first time virtual reality had been used for such a purpose in Brazil. The separation of the twins entailed seven surgeries, more than 30 hours of operating time, and almost a hundred medical staff members. [iii]

The video below further details the separation of the conjoined twin boys.

Conjoined twins were once named "siamise twins," named after the "first world-recognized set of conjoined twins born in 1811 in Siam, present-day Thailand." The term now is outdated and inappropriate. [iv]

Historically, conjoined twins were often made 'spectacles' or were made to be performers. One example of a pair of performing conjoined twins is Daisy and Violet Hilton, pictured below.
Daisy and Violet HiltonWellcome Images/Wikimedia Commons

The Hilton sisters were called a "sideshow act" during their time. Connected back to back, these twins were pygopagus twins. Even though they had their own separate internal organs, doctors refused to separate them. The twins were born out of wedlock, and their biological mother viewed them as punishment for her sin and handed them over to her employer, Mary Hilton. [v]

The girls were on display from that point on and eventually were granted entry into the United States. Despite being superstars performing with Charlie Chaplin and others, the girls were kept isolated from the world. They ultimately obtained legal counsel to regain control of their lives and finances. [vi]

Following their freedom, they starred in a movie, 'Chained for Life.' The movie flopped and was deemed an "exploitation film" exploiting conjoined twins. The video below provides the additional history of the twins. [vi]

Millie and Christine McKoy were conjoined twins sold into the entertainment business by their parent's owners.
Millie and Christine McKoyJohn H. Fitzgibbon/Wikimedia Commons

Millie and Christine were forced to be continually showcased in freak show circuses. After being sold multiple times, they were presented as the 'Carolina Girls' two-headed exhibit. Following this, the twins were stolen and exhibited privately before moving to England. Their mother eventually hunted down the twins and filed a suit to regain custody. [vii]

Their mother won the lawsuit and was able to move the twins back to North Carolina, where they developed impressive singing abilities. They continued to perform and eventually purchased their own home with their earnings. The video below provides additional details on the twins' path to eventual freedom. The girls asserted throughout their life that they had no desire to be separated. [viii]

The world has seemingly harbored an obsession with conjoined twins since the beginning of time. Neolithic terracotta figurines showed conjoined figures, as seen in the two photos below.
Neolithic conjoined figuresNYU
Neolithic conjoined figurine from VincaNYU

Paleolithic rock relief also depicts a representation of conjoined figures, as shown below.
Paleolithic rock relief from France representing conjoined figuresNYU

Many scholars previously thought conjoined individuals meant "a particular relation between two divinities or a magic sign." [ix]

In another unusual case, conjoined twins were born "ischiopagus tetrapus" conjoined in 2010. They were linked at the pelvis and had fused spines, spinal cords, and four legs. Jodie was healthier than Mary, with "an anatomically normal brain, heart, lungs, and liver." The two shared a common bladder and aorta. [ix]
Mary and Jodi, conjoined

On the other hand, Mary was severely abnormal with a "primitive brain." She could not survive independently, so a separation surgery would inevitably lead to her death. Three options that posed ethical and moral questions were presented.

  1. Continue the permanent union that would result in the inevitable death of both twins within roughly six months to a few years.
  2. Perform an elective separation with a 5%-6% chance of death at separation for Jodie but certain death for Mary.
  3. Perform an emergency separation with a 60% mortality projection rate for Jodie and 100% for Mary. [x]

The parents shared that they "accepted the status of their daughters as God's will and wanted to leave their daughters' fate in God's hands" and "asked that no medical interventions be utilized to prolong the tragic fate of their children." They did not want the surgery; however, a court ruled against them, allowing Jodie to be separated from Mary. If this were you, would you agree with the court's decision? [xi]


[i] Beverly L. Jenkins, 100 Professionals and 33 Hrs Later: Virtual Surgery Separates Conjoined Twins, (Aug, 18, 2022)

[ii] Id.

[iii] Id.

[iv] Aubrey Baily, PT, DPT, CHT, Everything You Need to Know About Conjoined Twins, (Dec. 10, 2021)

[v] Sal, The Tragic Life Story of the Conjoined Hilton Sisters, (Dec. 1, 2020)

[vi] Id.

[vii] John Macfie, McCoy, Millie-Christine [McKoy], (Dec. 2021)

[viii] Id.

[ix] Clare Dyer, Siamese twins to be separated against parents' will, (Sep. 2, 2000)

[x] Id.

[xi] Id.

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Currently pursuing a Juris Doctor at Western State, writer Charnell Gilchrist is writing her way through law school.

Aliso Viejo, CA

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