The growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report

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Conjoined twins are a rare congenital abnormality with an estimated incidence of 1:50,000 pregnancies and 1:200,000 live births. Pygopagus twins are characterized by sacrococcygeal fusion that is commonly associated with perineal and spinal abnormalities. Management of this complex disease requires a well-developed surgical system with multidisciplinary capacity and expertise.

A decade ago there were no dedicated pediatric neurosurgeons in southern Vietnam. This has changed within a few short years; there are now 10 dedicated pediatric neurosurgeons with continually expanding technical capacity. In August 2017 a multidisciplinary surgical and anesthetic team successfully separated female pygopagus twins with fused sacrum and spinal cord with associated myelomeningocele defect.

The authors present here the first successful separation of pygopagus twins in Vietnam as a representative case of gradual and sustainable pediatric neurosurgical scale-up.

ABBREVIATIONS CH2 = Children’s Hospital 2; LCoGS = Lancet Commission on Global Surgery.
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Contributor Notes

Correspondence Jacob R. Lepard: University of Alabama at Birmingham, AL. jlepard@uabmc.edu.INCLUDE WHEN CITING Published online January 17, 2020; DOI: 10.3171/2019.11.PEDS19291.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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  • 1

    Adejuyigbe OSowande OAOlabanji JKKomolafe EOFaponle FAdetiloye VA: Successful separation of two pairs of conjoined twins in Ile Ife, Nigeria: case reports. East Afr Med J 82:50542005

    • Search Google Scholar
    • Export Citation
  • 2

    Awasthi RIyengar RRege SJain N: Surgical management of pygopagus conjoined twins with spinal bifida. Eur Spine J 24 (Suppl 4):S560S5632015

    • Search Google Scholar
    • Export Citation
  • 3

    Brizot MLLiao AWLopes LMOkumura MMarques MSKrebs V: Conjoined twins pregnancies: experience with 36 cases from a single center. Prenat Diagn 31:112011252011

    • Search Google Scholar
    • Export Citation
  • 4

    Cook AEl-Gohary AKhoury AE: The use of a three-dimensional imaging model to optimize the operative separation of pygopagus conjoined twins. J Pediatr Urol 1:3213252005

    • Search Google Scholar
    • Export Citation
  • 5

    Dewan MCBaticulon RERattani AJohnston JMWarf BCHarkness W: Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide. Neurosurg Focus 45(4):E132018

    • Search Google Scholar
    • Export Citation
  • 6

    Dewan MCOnen JBow HSsenyonga PHoward CWarf BC: Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems. Neurosurg Focus 45(4):E22018

    • Search Google Scholar
    • Export Citation
  • 7

    Fieggen AGDunn RNPitcher RDMillar AJWRode HPeter JC: Ischiopagus and pygopagus conjoined twins: neurosurgical considerations. Childs Nerv Syst 20:6406512004

    • Search Google Scholar
    • Export Citation
  • 8

    Fowler CLPulito ARWarf BCVandenbrink KD: Separation of complex pygopagus conjoined twins. J Pediatr Surg 34:6196221999

  • 9

    Gul AAslan HCeylan Y: Prenatal diagnosis of pygopagus tetrapus parasitic twin: case report. BMC Pregnancy Childbirth 4:132004

  • 10

    Karras CLTran HMDornbos D IIINguyen PNimjee SMPrevedello DM: Inside Vietnam’s largest neurosurgery department. World Neurosurg 105:1221252017

    • Search Google Scholar
    • Export Citation
  • 11

    Kim SSWaldhausen JHTWeidner BCSGrady RMitchell MSawin R: Perineal reconstruction of female conjoined twins. J Pediatr Surg 37:174017432002

    • Search Google Scholar
    • Export Citation
  • 12

    Kobylarz K: Intensive care of conjoined twins. Anaesthesiol Intensive Ther 46:1301362014

  • 13

    Lazarus JRaad JRode HMillar A: Long-term urological outcomes in six sets of conjoined twins. J Pediatr Urol 7:5205252011

  • 14

    McDowell BCMorton BEJanik JSGerow RKHandler MHLowenstein AD: Separation of conjoined pygopagus twins. Plast Reconstr Surg 111:199820022003

    • Search Google Scholar
    • Export Citation
  • 15

    Meara JGLeather AJMHagander LAlkire BCAlonso NAmeh EA: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:5696242015

    • Search Google Scholar
    • Export Citation
  • 16

    Mian AGabra NISharma TTopale NGielecki JTubbs RS: Conjoined twins: from conception to separation, a review. Clin Anat 30:3853962017

    • Search Google Scholar
    • Export Citation
  • 17

    Nyundo MJahn AKayondo KNtirenganya FMuzungu KNtakiyiruta G: Successful separation of conjoined pygopagus twins in African environment with limited resources. Rwanda Med J 69:47502012

    • Search Google Scholar
    • Export Citation
  • 18

    O’Neill JA JrHolcomb GW IIISchnaufer LTempleton JM JrBishop HCRoss AJ III: Surgical experience with thirteen conjoined twins. Ann Surg 208:2993121988

    • Search Google Scholar
    • Export Citation
  • 19

    Pai K MNaidu RCRaja ARai YSKumar NKini A: Surgical nuances in the separation of craniopagus twins—our experience and a follow up of 15 years. Neurol India 66:4264332018

    • Search Google Scholar
    • Export Citation
  • 20

    Punchak MMukhopadhyay SSachdev SHung YCPeeters SRattani A: Neurosurgical care: availability and access in low-income and middle-income countries. World Neurosurg 112:e240e2542018

    • Search Google Scholar
    • Export Citation
  • 21

    Rocque BGDavis MCMcClugage SGTuan DAKing DTHuong NT: Surgical treatment of epilepsy in Vietnam: program development and international collaboration. Neurosurg Focus 45(4):E32018

    • Search Google Scholar
    • Export Citation
  • 22

    Rode HFieggen AGBrown RACywes SDavies MRQHewitson JP: Four decades of conjoined twins at Red Cross Children’s Hospital—lessons learned. S Afr Med J 96:9319402006

    • Search Google Scholar
    • Export Citation
  • 23

    Rosenfeld JVXuan NT: Neurosurgery in Vietnam. Surg Neurol 48:3073111997

  • 24

    Roy M: Anaesthesia for separation of conjoined twins. Anaesthesia 39:122512281984

  • 25

    Saguil EAlmonte JBaltazar WAcosta ACaballes ACatangui A: Conjoined twins in the Philippines: experience of a single institution. Pediatr Surg Int 25:7757802009

    • Search Google Scholar
    • Export Citation
  • 26

    Sara JPKydes APryjdun OJacoby MMcBride WPandya S: Anesthesia for pygopagus conjoined twins during single-twin and simultaneous pneumoperitoneum: a case report. A A Pract 11:71722018

    • Search Google Scholar
    • Export Citation
  • 27

    Shija JKNgiloi PJ: Final stage surgical treatment of the conjoined twins of Masasi, Tanzania: case report. East Afr Med J 77:1721732000

    • Search Google Scholar
    • Export Citation
  • 28

    Spitz L: Conjoined twins. Prenat Diagn 25:8148192005

  • 29

    Spitz L: Ethics in the management of conjoined twins. Semin Pediatr Surg 24:2632642015

  • 30

    Spitz LKiely EM: Experience in the management of conjoined twins. Br J Surg 89:118811922002

  • 31

    Tannuri ACABatatinha JAPVelhote MCPTannuri U: Conjoined twins: twenty years’ experience at a reference center in Brazil. Clinics (São Paulo) 68:3713772013

    • Search Google Scholar
    • Export Citation
  • 32

    Thomas JMLopez JT: Conjoined twins—the anaesthetic management of 15 sets from 1991–2002. Paediatr Anaesth 14:1171292004

  • 33

    Tran DA: Successful separation of ischiopagus tripus conjoined twins with one twin suffering from brain damage. J Pediatr Surg 28:9659681993

    • Search Google Scholar
    • Export Citation
  • 34

    Votteler TPLipsky K: Long-term results of 10 conjoined twin separations. J Pediatr Surg 40:6186292005

  • 35

    Winder MLaw A: Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience. J Clin Neurosci 13:9689752006

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