Introduction: Rachipagus parasiticus is an extremely rare condition. There are limited number of cases in the literature. It is considered by some authors as asymmetric conjoined twins in which the tissues of a severely defective twin (parasite) are dependent on vascular supply from the intact twin (autosite). Others, consider it is just an accessory limb attached to spinal dysraphism due to neural-tube defects.
Methods: A 21 days old girl, presented with a mass representing an aborted parasitic twin attached to the back in the midline over the lumbosacral region, formed of rudimentary pelvis with complete lower limb and a bud of the other with two depressions resembling an anal and genital dimples. Computed tomography, magnetic resonance imaging of the whole spine focusing on the lumbosacral spine showed a well-developed long bone and other small bones within the parasite, and the autosite showed lumbosacral spina bifida, and meningiomyelocele herniated into the parasitic twin.
Results: The neonate underwent operation at the age of 28 days; the duration of surgery was two and half hours. Neural tissue dissection was the most serious problem, as there wasn’t neuromonitoring available for this age, but the parasitic twin hadn’t neural attachment with the meningiomyelocele. Bleeding was the second serious problem, the main arterial supply to the parasite was identified and controlled, and supplementary blood transfusion was received. After separation of the parasitic legs, the dura was repaired. Skin and subcutaneous tissue were closed directly. The patient discharged from the hospital after 4 days, moving her lower limbs proximally with weakness in both feet.
Conclusions: Rachipagus parasiticus are rare and complicated anomalies. By detailed investigation, using microsurgical technique, neurophysiological monitoring and adequate control of intraoperative bleeding, a successful surgical separation was achieved.
Patient Care: My research put detailed discribtion of a rare condition that might face any neurosurgeon, and technical points on how to successfully separate the twin with minimum deficit possible.
the literature review, revealed that there is still debate about the condition and its origin
Learning Objectives: By the conclusion of this session, participants should be able to identify parasitic conjoined twins, how to manage them efficiently, how to deal with the parents, and avoid unintended risk during surgery.