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

Can, Dang Do Thanh; Lepard, Jacob; Tri, T Thanh; Duong, Tran Van; Thúy, Nguyễn Thị Diệu; Thach, Pham Ngoc; Johnston, James M.; Oakes, W. Jerry; A, Tran Dong

doi:10.3171/2019.11.peds19291

Cited by 3 publications

(1 citation statement)

References 31 publications

(13 reference statements)

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“…Thus, a local "same-culture" neurosurgeon is likely to provide significant benefit in the treatment of craniosynostosis, in addition to the more intuitive benefits of local pediatric neurosurgical care such as decreased travel and financial expenditure, among others. 38 Notably, no prior literature exists regarding the surgical treatment of craniosynostosis in Vietnam. Prior to this endeavor in subspecialty training, these cases occurred only rarely in Vietnam and were dependent on the physical presence of international volunteers, otherwise requiring families to travel abroad to seek care.…”

Section: Epidemiological Trendsmentioning

confidence: 99%

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Can

Lepard

Anh

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.

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Section: Epidemiological Trendsmentioning

confidence: 99%

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Can

Lepard

Anh

et al. 2021

Journal of Neurosurgery: Pediatrics

Self Cite

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The utility and post-operative evolution of head circumference in nonsyndromic single-suture craniosynostosis: a prospective study in Vietnamese children

et al. 2022

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Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report

et al. 2022

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Background Pygopagus is a type of conjoined twin binding at the buttocks. Some cases of pygopagus involve the fusion of the gastrointestinal tract, urinary tract, and spinal cord. Few cases of male pygopagus have been reported; however, the prognosis after separation is unclear. Herein, we report a case of male pygopagus in which successful separation was performed with the reconstruction of the anal canal. Case presentation Twins with male pygopagus were born at 35 weeks by cesarean section. They shared a common anus, penis, and scrotum with four testes. The infants had normal defecation and urination after birth. The separation surgery was scheduled when they were 5 months. Two distinct anesthesia teams and four surgical teams (neurosurgery, pediatric urology, plastic surgery, and pediatric surgery) were involved in the multidisciplinary approach. After separating the spinal cord, we found that the anal canal and sphincter muscle complex were fused near the anal aperture, and we separated them. The fused penis and testis were separated and reconstructed using the same incisional line as the other separation, and the reconstructions of the anal canals with the sphincter muscle complex were completed. Both patients had an uneventful postoperative course. At 2 years of age, they could walk and defecate independently. In addition, they voided spontaneously without urinary incontinence at the time of 3 years and 11 months. Conclusions Separation of the spinal cord with anal canal and urethral reconstruction is important for male pygopagus patients as it allows them to preserve their independent function.

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

Cited by 3 publications

References 31 publications

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

The utility and post-operative evolution of head circumference in nonsyndromic single-suture craniosynostosis: a prospective study in Vietnamese children

Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report

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