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Pygopagus Conjoined Twins: A Neurophysiologic Intraoperative Monitoring Schema

Cromeens, Barrett P.; McKinney, Jennifer L.; Leonard, Jeffrey R.; Governale, Lance S.; Brown, Judy L.; Henry, Christina M.; Levitt, Marc A.; Wood, Richard J.; Besner, Gail E.; Islam, Monica P.

Journal of Clinical Neurophysiology: March 2017 - Volume 34 - Issue 2 - p e5–e8
doi: 10.1097/WNP.0000000000000343
Case Report

Summary: Conjoined twins occur in up to 1 in 50,000 live births with approximately 18% joined in a pygopagus configuration at the buttocks. Twins with this configuration display symptoms and carry surgical risks during separation related to the extent of their connection which can include anorectal, genitourinary, vertebral, and neural structures. Neurophysiologic intraoperative monitoring for these cases has been discussed in the literature with variable utility. The authors present a case of pygopagus twins with fused spinal cords and imperforate anus where the use of neurophysiologic intraoperative monitoring significantly impacted surgical decision-making in division of these critical structures.

*Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.;

Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.;

Section of Neurology, Department of Clinical Pediatrics, The Ohio State University, Columbus, Ohio, U.S.A.;

§Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.; and

Neurodiagnostics Laboratory, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.

Address correspondence and reprint requests to Monica P. Islam, MD, Division of Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, U.S.A.; e-mail:

The authors have no funding or conflicts of interest to disclose.

The content of this article was presented at the 2016 Annual Meeting of the American Clinical Neurophysiology Society, Orlando, Florida, February 10-14, 2016.

© 2017 by the American Clinical Neurophysiology Society