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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.
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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.
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Performing microsurgery with the support of navigation in falcine meningioma management shows significant impacts in short and middle-time follow-up, including unilaterally skull opening with smallest and nearest skin incision, lessen the surgical duration, limit blood transfusion and prevent tumours from recurrence. Materials and methods: Sixty-two falcine meningioma patients treated by microoperation applying neuronavigation were enroled from July 2015 to March 2017. Patients are evaluated before and 1 year after surgery according to The Karnofsky Performance Scale (KPS) for comparison. Results: Histopathology: the most common was fibrous meningioma with 32.26%; meningothelial meningioma was 19.35% and transitional meningioma was 16.13%. KPS I before surgery was 6.45% and after was 83.87%. KPS III who needed assistance in activities preoperation was 64.52% and postoperation was 1.61%. After surgery, there was no disabled patient. All patients were followed up a year after surgery and received MRI to evaluate the recurrence. After 12 months, there were three recurrent cases, accounted for 4.84%. Conclusions: Microsurgery under neuronavigation help brings significant improvement in patient's functional abilities and low recurrence of falcine meningiomas within 1-year post-surgery. Further studies with large sample size and longer follow-up duration should be performed to reliably evaluate safety and effectiveness of microsurgical neuronavigation in the management of the disease.
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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.
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INTRODUCTION: Spinal extranodal Rosai-Dorfman disease (RDD) is extremely rare. In this paper, we reported successful management of spinal extranodal RDD and reviewed medical literature. CASE PRESENTATION: A 19-year-old male presented with progressive bilateral leg weakness and back pain for two months before admission. He denied weight loss, fever, night sweats, and lymph node enlargement. On examination, his muscle strength of both legs was grade I with hyperreflexia. Magnetic resonance imaging of the spine (MRI) showed a thoracic extradural mass at a level of T6-T9, which was a heterogeneous hyperintense on T2W, STIR, and isointense on T1W and enhanced contrast vividly. We resected the tumor totally and decompressed the spinal cord. Pathology revealed a histiocytic tumor. Immunohistochemical staining was S100 (+), CD68 (+), CD45 (+), and CD1a (-). Postoperatively, his muscle strength improved gradually to grade IV after four months. Postoperative MRI of the spine showed no residual tumor. No further adjuvant therapy was indicated. CLINICAL DISCUSSION: Spinal extranodal RDD has no specific symptoms and pathognomonic imaging features. CT and MRI of the spine are still the essential tools for diagnosing RDD, but biopsy is often mandatory for definitive diagnosis. There have not been consensus guidelines for treating RDD of the spine because of its rarity. Surgical resection remained the mainstay of treatment (78.8%), with or without adjuvant therapies. CONCLUSION: Surgery is the treatment of choice for most cases, while steroid therapy, radiotherapy, and chemotherapy should be adjuvant treatment and tailored individually.
