Temporal Lobe Surgery for Epilepsy in a Resource-Limited Vietnamese Cohort.

BACKGROUND: Epilepsy surgery is traditionally difficult to pursue in resource-limited countries but is nevertheless essential in the treatment of medication-refractory, surgically amenable epilepsy. METHODS: With the help of international collaboration, a successful epilepsy program was started in Vietnam. This article comprises a retrospective chart review, combined with prospective longitudinal follow-up of 35 cases of unilateral drug-resistant epilepsy in the temporal lobe who underwent temporal lobectomy, in Viet Duc University Hospital from May 2018 to September 2022. RESULTS: The female/male ratio was 0.6:1, and focal seizures with impaired awareness accounted for 97.14% of patients. Of patients with focal awareness seizures, 51.41% were localized and detected by electroencephalography. Postoperatively, 80% of patients were seizure free (Engel I) at 1 year, and the remaining 20% had worthwhile seizure improvement (Engel II). Postoperative temporal lobe pathology was categorized as follows: mesial temporal sclerosis (48.57%), focal cortical dysplasia (25.71%), and low-grade neoplasms (25.71%). Of patients, 17.14% had postoperative complications (5 infections and 1 transient extremity paresis), and there were no deaths. CONCLUSIONS: Even in low-resource environments, effective and safe surgical care can be provided for drug-resistant epilepsy caused by temporal lobe disease. This study serves as a model of international collaboration and support for future hospitals in low-resource environments to replicate.

Microsurgery for drug resistance epilepsy due to temporal lobe lesions in a resource limited condition: a cross-sectional study.

Epilepsy is a prevalent neurological condition that affects individuals of all ages and genders worldwide. Surgical intervention for drug-resistant epilepsy has been found to improve quality of life, with patient independence being of utmost importance. Methods: The study was a retrospective and prospective cross-sectional study of 35 cases of drug-resistant temporal lobe epilepsy. All patients were operated on by the primary author between May 2018 and September 2022. The study evaluated various factors including clinical characteristics, electroencephalogram, magnetic resonance imaging, surgical outcomes, and histopathology. Results: The success rate of the surgeries (74.3%) is similar to those reported in high-income countries. 51.4% underwent selective amygdalohippocampectomy for cases that localized to the mesial temporal lobe. Lateral/neocortical lesions underwent lesionectomy (48.6%). Our study found a complication rate of 17.1%: meningitis (8.5%), trainset focal paralysis (2.9%), and soft tissue infection (5.7%). There were no mortalities. Conclusions: The article showcases an international collaborative effort that demonstrates the possibility of providing highly effective and safe surgical care for temporal lobe epilepsy even in low-resource environments. The authors hope that this model can be replicated in other areas with similar resource limitations.

Duodenal perforation as a postoperative complication after ventriculoperitoneal shunt: A case report.

INTRODUCTION AND IMPORTANCE: Ventriculoperitoneal shunt (VP shunt) is the one of the most common and important tools for the treatment of hydrocephalus. It requires simple technique and demonstrates effectiveness in treating hydrocephalus. However, many complications have been reported such as infection, valve obstruction, valve dysfunction and abdominal complications. Complications of intestinal perforation and catheter penetrating the intestine are very rare, accounting for 0.01-0.07% of abdominal complications. In the literature, 94 cases of intestinal perforation and catheter penetration and only 2 cases of duodenal perforation have been reported. CASE PRESENTATION: In this study, we report a successful surgical treatment of a duodenal perforation complication after 5 months of VP shunt. Gastroscopy showed the distal tip penetrating into the D2 segment of the duodenum. Surgery was performed to relocate the abdominal tip and to repair the perforation. Meningitis was treated with antibiotics. The patient was stable and discharged after 3 weeks. CLINICAL DISCUSSION: The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. CONCLUSION: Intestinal perforation with VP shunt catheter is rare. Diagnosis is simple if the catheter comes out of the anus, mouth, vagina, penis, scrotum, navel. In case when the catheter is inside the lumen of the gastrointestinal tract, diagnosis often requires imaging such as abdominal computed tomography, and gastrointestinal endoscopy. Surgery treatment was to replace the drainage valve and to close the perforation the digestive tract.

Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report.

INTRODUCTION AND IMPORTANCE: Pituitary apoplexy is defined as a sudden onset of neurologic deficit due to infarction or hemorrhage of the pituitary tumor. We report a case of emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction due to ICA compression in a limited resources condition. CASE PRESENTATION: A 38-year-old female presented with acute onset of severe headache, decreased level of consciousness, decreased visual acuity bilaterally, aphasia, and right hemiparesis. Computed tomography angiography showed a hyperdense sellar mass with stenosis of the left ICA. The patient underwent emergent endoscopic transsphenoidal surgery for sellar decompression. CLINICAL DISCUSSION: The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. CONCLUSION: Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. Pituitary apoplexy presenting as cerebral infarction is rare. The aim of surgery in emergency setting was sellar decompression. Endoscopic transsphenoidal surgery was an effective treatment.

Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report.

INTRODUCTION AND IMPORTANCE: Epidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam. CASE PRESENTATION: A 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5-S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal. CLINICAL DISCUSSION: The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. CONCLUSION: Diagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful.

Spontaneous cranial bone regeneration following craniectomy for traumatic brain injury in a pregnant woman: A case report.

INTRODUCTION AND IMPORTANCE: Spontaneous bone formation following craniectomy is an extremely rare in adult. As in the medical literature, this is the first case report on total spontaneous ossification following craniectomy in a pregnant woman. CASE PRESENTATION: In this paper, we reported a 20-year-old female currently in the 30th week of her pregnancy suffered from head trauma following motorcycle accident. On admission to our hospital, her GCS score was 3 points. She was treated with emergency extradural hematoma evacuation with craniectomy and Caesarean section with uterine artery ligation. 3 weeks post-operation, the patient and her daughter were discharged from the hospital. At follow-up, spontaneous cranial bone generation was observed. CLINICAL DISCUSSION: The presentation, diagnosis and strategy of treatments were discussed. CONCLUSION: Diagnostic imaging in traumatic pregnant patient is often postponed for the concern of fetus exposure to radiation. Traumatic pregnant patient with possible head trauma should be transferred to a center with expertise in neurotrauma and obstetrical care. Spontaneous cranial bone regeneration following craniectomy in adult is rare. Surgery techniques and hormones in pregnancy contribute to bone formation.

Endoscopic-assisted microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: A case report.

INTRODUCTION AND IMPORTANCE: Trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) was a rare condition. This paper reported a successful endoscopic-assisted microvascular decompression (MVD) for TN secondary to VBD. CASE PRESENTATION: A 53-year-old male with a history of myocardial infarction and heart failure complained of left refractory facial pain three years prior to admission. His pain was intermittent, electrical-like, severe, sharp, and radiated along the maxillary and mandibular branches. He used carbamazepine 600 mg daily. Brain magnetic resonance imaging revealed a neurovascular conflict between VBD and the left trigeminal nerve. The endoscopic-assisted MVD was indicated. The shredded neurosurgical sponges were interposed between VBD and trigeminal nerve. The 0° and 30° rigid rod-lens endoscope was used to explore and confirm the complete decompression. Postoperatively, TN was disappeared entirely. At a three-month postoperative, no facial pain and paraesthesia were found. The patient discontinued carbamazepine permanently. CLINICAL DISCUSSION: MVD was still the most effective treatment. An inspection of root entry zone (REZ) and complete MVD with a solely operating microscope were challenging due to the massive diameter of VBD and multiple offending arteries behind the VBD. However, the wide viewing field and high-quality resolution of endoscopes allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction. This is essential in case of less potential space created by VBD. CONCLUSION: Endoscope-assisted MVD allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction in management of trigeminal neuralgia secondary to VBD.

Surgical management of cerebral peduncle neurocysticercosis: A case report of decision making in a resource-restricted environment.

BACKGROUND: Diagnosis and treatment of neurocysticercosis have always been a challenge, especially in Vietnam, a resource-restricted environment. Here, we reported successful surgical management of cerebral peduncle neurocysticercosis. PRESENTATION OF CASE: A 65-year-old man with no medical history complained of headache and progressive right-sided hemiparesis for one month prior to admission. On examination, his muscle strength was 3/5 (Frankel grade) with positive Hoffmann and Babinski's signs on the right side. His brain's magnetic resonance imaging suggested a cystic brain tumor (29 × 18 mm) situated in the left cerebral peduncle and hypothalamus region. Enzyme-linked immunoassays (ELISA) of serum for Cysticercus cellulosae, Echinococcus, Toxocara, and Amebiasis were negative. The operation was performed with the modified frontotemporal-orbitozygomatic approach. We extirpated both the cysts. Histopathological examination revealed the larva of Taenia solium. Postoperatively, the hemiplegia was completely recovered, and no complication was reported DISCUSSION: The most recent revised diagnostic criteria of neurocysticercosis emphasised that neuroimaging studies play the most crucial role while clinical manifestations and exposure criteria were only indirect proofs of neurocysticercosis. Neuroimaging and clinical evidence in this patient, however, were more suggestive of cystic brain tumor, which was our most likely preoperative diagnosis. Consequently, total tumor resection required for both histopathological examination and alleviating his hemiplegia. CONCLUSIONS: Preoperative diagnosis of neurocysticercosis has always been a challenge. Total resection of the cerebral peduncle neurocysticercosis was adequate when the patient had localized neurological deficits.

Infected intradural dermoid cyst without dermal sinus tract mimicking brain abscess: A case report.

INTRODUCTION: Infection is a rare complication of intradural dermoid cyst. We reported an infected intradural dermoid cyst without dermal sinus tract mimicking brain abscess. PRESENTATION OF CASE: A 4-year-old boy with no medical history complained of a palpable mass on his head. On examination, the occipital palpable mass was firm and immobile, had no redness, swelling, and pain. The preoperative MRI showed a well-defined, ring-enhancing lesion. White blood count was 12.8 × 109  cells/liter. We have sought no other infection sites. We encountered intraoperatively the pus from the infected mass invading subcutaneous layer and skull bone. We excised completely the tumor and carefully coagulated the residual capsule invading superior sagittal sinus. Histopathological examination was infected dermoid cyst. The infection agent was Staphylococcus aureus. The patient was received systemic antibiotic therapy for 21 days following oral antibiotics for 1 month. He was discharged with no complications. DISCUSSION: The diagnosis of infected dermoid cyst was often based on MRI images and especially dermal sinus tract. However, in the absence of a dermal sinus tract, preoperative diagnosing an infected dermoid cyst might be very challenging. The ideal treatment of the dermoid cyst was total resection of the cyst with the epithelial lining. Nevertheless, due to the benign nature of dermoid cyst, adequate gross total resection with meticulous hemostasis the residual capsule firmly adhering eloquent areas and major vessels was more appropriate. CONCLUSION: Diagnosing infected dermoid cyst with no dermal sinus might be challenging. Systemic antibiotic therapy after gross total resection was an effective treatment.