{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:53:54Z","timestamp":1770116034546,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Conjoined twins are a rare type of congenital malformation. The point of attachment is the primary factor used to classify conjoined twins; typically, this is front to front, with thoracopagus and omphalopagus twins accounting for about 75% of cases and pygopagus twins only between 6% and 19%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This is a case report of 46-day-old female triplets born to a 37-year-old para 4 mother. Triplets A and B were conjoined at the lumbosacrococcygeal area dorsally. Triplet C was not conjoined. The conjoined triplets had a low birth weight; hence, it was decided to start nutritional management and achieve adequate weight gain before surgical separation. While on nutritional management, at 46 days of age, triplet B developed cardiorespiratory failure. Therefore, the multidisciplinary team decided to proceed with emergency neurosurgical separation surgery, with the primary aim of saving triplet A. Triplet B died 7 hours after the surgery due to irreversible cardiorespiratory failure, and triplet A remained in the hospital for 14 days and was discharged with intact neurological function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Most cases of conjoined twins do not require emergency separation surgery and need nutritional support before the separation procedure. Separation surgery requires a multidisciplinary team meeting, planning ahead of time, and preparation.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24818\">https:\/\/thejns.org\/doi\/10.3171\/CASE24818<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24818","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T20:14:14Z","timestamp":1745871254000},"source":"Crossref","is-referenced-by-count":0,"title":["Emergency neurosurgical separation of pygopagus conjoined twins in a triplet pregnancy: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Endris Hussen","family":"Ali","sequence":"first","affiliation":[{"name":"Unit of Neurosurgery, Ethiopian Police Hospital, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yared Nigusie","family":"Abebe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Paul\u2019s Millennium Medical College Hospital, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8733-8134","authenticated-orcid":true,"given":"Milena Gebreegziabher","family":"Haile","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Paul\u2019s Millennium Medical College Hospital, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abera","family":"Bayable","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Paul\u2019s Millennium Medical College Hospital, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"APSP J Case Rep","first-page":"5","article-title":"Ischiopagus tripus conjoined twins","volume":"2","author":"Khan","year":"2011","unstructured":"Khan YA.Ischiopagus tripus conjoined twins. APSP J Case Rep. 2011;2(1):5."},{"issue":"3","key":"bib2","series-title":"J Pediatr Surg Case Rep","first-page":"119","article-title":"Surgical separation of pygopagus twins: a case report","volume":"2","author":"Jain","year":"2014","unstructured":"Jain PKundal AKSharma RKhilnani PKumar PKumar P.Surgical separation of pygopagus twins: a case report. J Pediatr Surg Case Rep. 2014;2(3):119-122."},{"issue":"9","key":"bib3","series-title":"J Neurosurg Case Lessons","first-page":"CASE218","article-title":"Successful neurosurgical separation of conjoined spinal cords in pygopagus twins: illustrative cases","volume":"1","author":"Yokota","year":"2021","unstructured":"Yokota CKagawa NBamba YSuccessful neurosurgical separation of conjoined spinal cords in pygopagus twins: illustrative cases. J Neurosurg Case Lessons. 2021;1(9):CASE218."},{"issue":"4","key":"bib4","series-title":"Childs Nerv Syst","first-page":"699","article-title":"Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review","volume":"29","author":"Hirokazu","year":"2013","unstructured":"Hirokazu TTakayuki IYoshinori HKazunari KAkio AKeiji K.Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review. Childs Nerv Syst. 2013;29(4):699-706."},{"key":"bib5","series-title":"J Pediatr Surg Case Rep","article-title":"Successful separation of pygopagus conjoined twins: a case report","volume":"99","author":"Sabeh-Ayoun","year":"2023","unstructured":"Sabeh-Ayoun KAl Tahan HAkel SZaghal A.Successful separation of pygopagus conjoined twins: a case report. J Pediatr Surg Case Rep. 2023;99."},{"issue":"3","key":"bib6","series-title":"J Pediatr Surg","first-page":"586","article-title":"Successful separation of pygopagus conjoined twins","volume":"41","author":"Matta","year":"2006","unstructured":"Matta HJacobsz AAuchincloss JSuccessful separation of pygopagus conjoined twins. J Pediatr Surg. 2006;41(3):586-588."},{"key":"bib7","series-title":"Int Med Case Rep J","first-page":"425","article-title":"A case of ischiopagus dicephalus conjoined twins with tetrabrachius bipus from Dessie, Ethiopia","volume":"15","author":"Alene","year":"2022","unstructured":"Alene TDAbebe MS.A case of ischiopagus dicephalus conjoined twins with tetrabrachius bipus from Dessie, Ethiopia. Int Med Case Rep J. 2022;15:425-429."},{"issue":"8-9","key":"bib8","series-title":"Childs Nerv Syst","first-page":"635","article-title":"Management of pyopagus conjoined twins","volume":"20","author":"Hockley","year":"2004","unstructured":"Hockley ADGornall PWalsh RManagement of pyopagus conjoined twins. Childs Nerv Syst. 2004;20(8-9):635-639."},{"issue":"suppl 4","key":"bib9","series-title":"Eur Spine J","first-page":"S560","article-title":"Surgical management of pygopagus conjoined twins with spinal bifida","volume":"24","author":"Awasthi","year":"2015","unstructured":"Awasthi RIyengar RRege SJain N.Surgical management of pygopagus conjoined twins with spinal bifida. Eur Spine J. 2015;24(suppl 4):S560-S563."},{"issue":"3","key":"bib10","series-title":"Childs Nerv Syst","first-page":"183","article-title":"Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature","volume":"19","author":"Fieggen","year":"2003","unstructured":"Fieggen GMillar ARode HNgiloi PAndronikou SPeter J.Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature. Childs Nerv Syst. 2003;19(3):183-187."},{"issue":"4","key":"bib11","series-title":"J Neurosurg Pediatr","first-page":"445","article-title":"The growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report","volume":"25","author":"Can","year":"2020","unstructured":"Can DDTLepard JRTri TTThe growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report. J Neurosurg Pediatr. 2020;25(4):445-451."},{"issue":"5","key":"bib12","series-title":"Journal of Pediatric Surger","first-page":"554","article-title":",","volume":"14","author":"Cloutier","year":"1979","unstructured":"Cloutier RLevasseurL,CoptyM,RoyJP. The surgical separation of pygopagous twins. Journal of Pediatric Surger. 1979;14(5):554-556."},{"issue":"7","key":"bib13","series-title":"Childs Nerv Syst","first-page":"1949","article-title":"Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls","volume":"39","author":"Mahmoud","year":"2023","unstructured":"Mahmoud MAElshawady SBKorkar GHHussein SMElserry THMahmoud MWS.Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls. 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Springer; 2022;8:43."},{"issue":"9","key":"bib16","series-title":"J Pediatr Surg","first-page":"e25","article-title":"Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins","volume":"46","author":"Chou","year":"2011","unstructured":"Chou YCPeng HCChu CHSuccessful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins. J Pediatr Surg. 2011;46(9):e25-e27."},{"issue":"1","key":"bib1","series-title":"APSP J Case Rep","first-page":"5","article-title":"Ischiopagus tripus conjoined twins","volume":"2","author":"Khan","year":"2011","unstructured":"Khan YA.Ischiopagus tripus conjoined twins. APSP J Case Rep. 2011;2(1):5."},{"issue":"3","key":"bib2","series-title":"J Pediatr Surg Case Rep","first-page":"119","article-title":"Surgical separation of pygopagus twins: a case report","volume":"2","author":"Jain","year":"2014","unstructured":"Jain PKundal AKSharma RKhilnani PKumar PKumar P.Surgical separation of pygopagus twins: a case report. J Pediatr Surg Case Rep. 2014;2(3):119-122."},{"issue":"9","key":"bib3","series-title":"J Neurosurg Case Lessons","first-page":"CASE218","article-title":"Successful neurosurgical separation of conjoined spinal cords in pygopagus twins: illustrative cases","volume":"1","author":"Yokota","year":"2021","unstructured":"Yokota CKagawa NBamba YSuccessful neurosurgical separation of conjoined spinal cords in pygopagus twins: illustrative cases. J Neurosurg Case Lessons. 2021;1(9):CASE218."},{"issue":"4","key":"bib4","series-title":"Childs Nerv Syst","first-page":"699","article-title":"Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review","volume":"29","author":"Hirokazu","year":"2013","unstructured":"Hirokazu TTakayuki IYoshinori HKazunari KAkio AKeiji K.Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review. Childs Nerv Syst. 2013;29(4):699-706."},{"key":"bib5","series-title":"J Pediatr Surg Case Rep","article-title":"Successful separation of pygopagus conjoined twins: a case report","volume":"99","author":"Sabeh-Ayoun","year":"2023","unstructured":"Sabeh-Ayoun KAl Tahan HAkel SZaghal A.Successful separation of pygopagus conjoined twins: a case report. J Pediatr Surg Case Rep. 2023;99."},{"issue":"3","key":"bib6","series-title":"J Pediatr Surg","first-page":"586","article-title":"Successful separation of pygopagus conjoined twins","volume":"41","author":"Matta","year":"2006","unstructured":"Matta HJacobsz AAuchincloss JSuccessful separation of pygopagus conjoined twins. J Pediatr Surg. 2006;41(3):586-588."},{"key":"bib7","series-title":"Int Med Case Rep J","first-page":"425","article-title":"A case of ischiopagus dicephalus conjoined twins with tetrabrachius bipus from Dessie, Ethiopia","volume":"15","author":"Alene","year":"2022","unstructured":"Alene TDAbebe MS.A case of ischiopagus dicephalus conjoined twins with tetrabrachius bipus from Dessie, Ethiopia. Int Med Case Rep J. 2022;15:425-429."},{"issue":"8-9","key":"bib8","series-title":"Childs Nerv Syst","first-page":"635","article-title":"Management of pyopagus conjoined twins","volume":"20","author":"Hockley","year":"2004","unstructured":"Hockley ADGornall PWalsh RManagement of pyopagus conjoined twins. Childs Nerv Syst. 2004;20(8-9):635-639."},{"issue":"suppl 4","key":"bib9","series-title":"Eur Spine J","first-page":"S560","article-title":"Surgical management of pygopagus conjoined twins with spinal bifida","volume":"24","author":"Awasthi","year":"2015","unstructured":"Awasthi RIyengar RRege SJain N.Surgical management of pygopagus conjoined twins with spinal bifida. Eur Spine J. 2015;24(suppl 4):S560-S563."},{"issue":"3","key":"bib10","series-title":"Childs Nerv Syst","first-page":"183","article-title":"Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature","volume":"19","author":"Fieggen","year":"2003","unstructured":"Fieggen GMillar ARode HNgiloi PAndronikou SPeter J.Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature. Childs Nerv Syst. 2003;19(3):183-187."},{"issue":"4","key":"bib11","series-title":"J Neurosurg Pediatr","first-page":"445","article-title":"The growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report","volume":"25","author":"Can","year":"2020","unstructured":"Can DDTLepard JRTri TTThe growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report. J Neurosurg Pediatr. 2020;25(4):445-451."},{"issue":"5","key":"bib12","series-title":"Journal of Pediatric Surger","first-page":"554","article-title":",","volume":"14","author":"Cloutier","year":"1979","unstructured":"Cloutier RLevasseurL,CoptyM,RoyJP. The surgical separation of pygopagous twins. Journal of Pediatric Surger. 1979;14(5):554-556."},{"issue":"7","key":"bib13","series-title":"Childs Nerv Syst","first-page":"1949","article-title":"Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls","volume":"39","author":"Mahmoud","year":"2023","unstructured":"Mahmoud MAElshawady SBKorkar GHHussein SMElserry THMahmoud MWS.Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls. Childs Nerv Syst. 2023;39(7):1949-1955."},{"issue":"2","key":"bib14","series-title":"J Clin Neurophysiol","first-page":"e5","article-title":"Pygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema","volume":"34","author":"Cromeens","year":"2017","unstructured":"Cromeens BPMcKinney JLLeonard JRPygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema. J Clin Neurophysiol. 2017;34(2):e5-e8."},{"key":"bib15","series-title":"Surg Case Rep","first-page":"43","article-title":"Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report","volume":"8","author":"Toyama","year":"2022","unstructured":"Toyama CTazuke YYokota CSuccessful separation of male pygopagus with anal canal and urethral reconstruction: a case report. Surg Case Rep. Springer; 2022;8:43."},{"issue":"9","key":"bib16","series-title":"J Pediatr Surg","first-page":"e25","article-title":"Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins","volume":"46","author":"Chou","year":"2011","unstructured":"Chou YCPeng HCChu CHSuccessful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins. 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