ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Background: Neuronavigation has been applied in neurocenters to help neurosurgeons plan the way to resect tumor totally and decline the neuro-injuries. This study aims to initially evaluate the result of microsurgery applying neuronavigation in treating falcine meningioma, which has not been reported comprehensively in Vietnam. Materials and methods: This cross-sectional study enrolled 62 patients diagnosised with falcine meningioma and treated by applying neuronavigation in operation in Neurosurgery Department of Military Hospital 103 and Viet Duc University Hospital from July 2015 to March 2017. Patients were assessed complications as well as residual lesions. Evaluate surgical results when discharging from hospital according to Ojemann MD standard. Results: Mean tumor volume was 67.37 ± 66.61 cm³ (range 6-370 cm³). Unilateral access site was the most common with 85.48%. Mean surgery duration was 209.84 ± 70.86 min. There were 27 out of 62 patients (43.55%) need blood transfusion in surgery. Tumor volume had an impact on blood transfusion in operation with p = 0.002. 82.26% of patients had total resection (Simpson I,II). There were 4.84% of patients having haemorrhage and 3 patients (4.84%) had wound infection after operation. Short-term outcome was evaluated according to Ojemann MD standard: good outcome was 67.74%, medium 17.74%, and poor outcome 14.52%. Conclusions: The application of neuronavigation and microsurgery enables surgeons to access falcine meningiomasare exactly, lessen the surgery duration, limit blood transfusion and complications after operation.
