Objective: Although epilepsy surgery is more effective than medical therapy for drug-resistant patients, it is underutilized in both high-income and low-and middle-income countries. In light of our efforts to establish an epilepsy surgery program in a resource-limited setting, this study aimed to determine the outcome of the epilepsy surgery program in Ho Chi Minh City (HCMC), Vietnam. Methods:In 2018, we developed the HCMC epilepsy core multidisciplinary team with members from various hospitals and centers. The team typically included neurologists, neurosurgeons, neuropsychologists, psychiatrists, and nursing specialists. Presurgical evaluations were performed for patients with drug-resistant epilepsy, fulfilling the ILAE criteria, with an epileptogenic lesion (mesial temporal sclerosis, low-grade gliomas, or focal cortical dysplasia). All epilepsy surgeries were performed in two epilepsy surgery centers in HCMC between 2018 and 2021. The patients were followed up for at least 12 months.Results: Fifty-two patients with drug-resistant epilepsy underwent presurgical evaluation, of which 35 underwent surgery. Among the 52 patients, 20 (38.5%) underwent surgery after showing concordance among the results of standard presurgical assessments such as semiology, scalp interictal or ictal electroencephalography, and brain imaging. Among the 26 people with epilepsy who required more advanced evaluations, 15 underwent surgery with intraoperative electrocorticography to delineate the optimal resection borders.The outcomes of Engel Class I and Class II were achieved in 29/35 (82.8%) and 6/35 (17.2%) patients, respectively.

The current report is the first of its kind in describing the neurosurgical training in modern-day Vietnam. Starting with in-depth face-to-face interviews, followed by electronically distributed questionnaires, a detailed picture of the training systems emerged.Neurosurgical training in Vietnam is multifaceted and dichotomous. The country of nearly 100 million people currently has only one neurosurgery-specific residency program, at the University of Medicine and Pharmacy at Ho Chi Minh City (UMPHCMC). This program lasts for 3 years, and Westerners might recognize many similarities to programs native to their countries. A similar training program exists in the north, at the Hanoi Medical University, but at this institution, trainees focus on neurosurgery only in the final year of their 3-year training. Neurosurgical training that resembles the program in Hanoi permeates the rest of the country, and the goal for all of the programs is to rapidly produce surgeons who can be dispersed throughout the country to treat patients requiring urgent neurosurgical procedures who are medically unsuitable for transfer to large urban centers and multispecialty hospitals. For the privilege of practicing elective neurosurgery, trainees around the country are required to acquire further training in Ho Chi Minh City or Hanoi or during fellowships abroad.A clear description of the neurosurgical training systems in Vietnam is hard to achieve, as there exist many diverse pathways and no standard definition of the endpoint for training. Unification and a clearer certification standard will likely help to elevate the standards of training and the state of neurosurgical practice in Vietnam.

Purpose: Seizures have a significant impact on the quality of life of those who suffer. This study aimed to evaluate the variables that influence the incidence of seizures during the perioperative period and effective measures to enhance epilepsy outcomes among individuals undergoing surgical resection of brain tumors. Methods: The authors carried out a prospective observational analysis of all patients who experienced seizures before their brain tumor surgery at UMC, HCMC between 2020 and 2022. Results: 54 cases presented with seizures were enrolled for the study, generalized seizure was the most prevalent seizure type (61.1%), followed by focal seizure (29.6%). Low-grade gliomas and frontotemporal lobe tumors increase the postoperative risk of seizure. Other predictive factors are a prolonged history of seizure, especially resistant epilepsy and major peritumoral edema. In contrast, gross total resection reduces postoperative seizure incidence. There was correlation between Ki67 proliferation index and seizure incidence in both low-grade and high-grade gliomas. ECoG made insubstantial difference in enhancing the epilepsy surgery outcome. Overall, 88.9% of patients were seizure-free at 6 months of follow-up (Engel Class I), 7.4% were almost seizure-free (Class II), and 3.7% had significant improvement (Class III), figures for 12-month follow-up were 87.0%, 9.3%, and 3.7% respectively. Conclusion: The majority of patients presented with seizures are those who were diagnosed with glioma. Postoperatively, most of the patients were seizure-free or had meaningful improvement. A shorter history of seizure and gross-total resection appear to be associated with a favorable prognosis for seizure control.

Seizures have a significant impact on the quality of life of those who suffer. This study aimed to evaluate the variables that influence the incidence of seizures during the perioperative period and effective measures to enhance epilepsy outcomes among individuals undergoing surgical resection of brain tumors. The authors carried out a prospective observational analysis of all patients who experienced seizures before their brain tumor surgery at UMC, HCMC between 2020 and 2022. 54 cases presented with seizures were enrolled for the study, generalized seizure was the most prevalent seizure type (61.1%), followed by focal seizure (29.6%). The majority of patients presented with seizures are those who were diagnosed with glioma. Low-grade gliomas and frontotemporal lobe tumors increase the postoperative risk of seizure. Other predictive factors are a prolonged history of seizure, especially resistant epilepsy and major peritumoral edema. In contrast, gross total resection reduces postoperative seizure incidence. There was correlation between Ki67 proliferation index and seizure incidence in both low-grade and high-grade gliomas. ECoG made insubstantial difference in enhancing the epilepsy surgery outcome. Overall, 88.9% of patients were seizure-free at 6 months of follow-up (Engel Class I), 7.4% were almost seizure-free (Class II), and 3.7% had significant improvement (Class III), figures for 12-month follow-up were 87.0%, 9.3%, and 3.7% respectively. A shorter history of seizure and gross-total resection appear to be associated with a favorable prognosis for seizure control.

No abstract