Outcome of Microsurgery for Arteriovenous Malformations in a Resource-Restricted Environment: Single-Surgeon Series from Vietnam

Jean, Walter C.; Huynh, Trong; Tai, Alexander; Felbaum, Daniel R.; Syed, Hasan R.; Ngo, Hung Manh

doi:10.1016/j.wneu.2019.08.256

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…There are government-derived financial incentives for patients to seek care in hospitals at the lowest level possible, such that they do not flood the central specialty hospitals in the large urban centers. 2 The training system for neurosurgeons is also designed to fit the structure of this overall healthcare system, and the main impetus is to train a large number of neurosurgeons in the shortest time possible to disperse throughout the country to perform urgent but relatively simple neurosurgical procedures. With the large number of road accidents in Vietnam, the majority of these procedures relate to neurosurgical trauma.…”

Section: Discussionmentioning

confidence: 99%

“…As an LMIC with a per capita healthcare expenditure equivalent to 1% that of the United States, it is perhaps not surprising that technologically driven, and therefore expensive, subspecialties of neurosurgery, such as epilepsy surgery, radiosurgery, and endovascular therapy, are rarely practiced in Vietnam. 2,4 As the practice of neurosurgery advances in Vietnam, the training in these areas will have to progress rapidly to catch up. As a system focused on producing practitioners quickly to fit the needs of the country, the training is perhaps overfocused on technical operative skills at the expense of understanding the disease processes and indication for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, departments throughout Vietnam showcase world-class neurosurgeons who routinely perform complex procedures without high-tech equipment (e.g., Doppler or indocyanine green microscopy) that would buffer the margin of error. 2 There is little doubt that, when harnessed properly, these strengths can translate into world-class neurosurgical training. Perhaps the most important ingredient missing in Vietnam is a governing neurosurgical body, such as a neurosurgery board.…”

Section: Discussionmentioning

confidence: 99%

“…4). 2 However, there is currently no set curriculum, case logs or minimums, neurosurgical lecture schedule, or access to cadaver dissection.…”

Section: Hanoi and The Northern Regionmentioning

confidence: 99%

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A system divided: the state of neurosurgical training in modern-day Vietnam

Jean

Huynh

Pham

et al. 2020

Neurosurgical Focus

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…4). 2 However, there is currently no set curriculum, case logs or minimums, neurosurgical lecture schedule, or access to cadaver dissection.…”

Section: Hanoi and The Northern Regionmentioning

confidence: 99%

See 2 more Smart Citations

A system divided: the state of neurosurgical training in modern-day Vietnam

Jean

Huynh

Pham

et al. 2020

Neurosurgical Focus

Self Cite

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“…Endovascular treatment was supposed to be more related to the recurrence risk than surgery, as it required longer term of follow-up, and endovascular materials were perceived as non-durable. Besides, the cost of treatment was one essential factor supporting our decision, since endovascular method costs much higher than surgery in Vietnam [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Microsurgery for a ruptured intracranial aneurysm in a 3-year-old child: A case report

Ngo

Chu

Nguyen

2020

International Journal of Surgery Case Reports

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Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls

et al. 2021

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Background We wanted to understand how patients with different modified Rankin Scale (mRS) grades differ regarding their health-related quality of life (HRQoL) and how this affects the interpretation and dichotomization of the grade. Methods In 2016, all adult patients in our brain arteriovenous malformation (AVM) database (n = 432) were asked to fill in mailed letters including a questionnaire about self-sufficiency and lifestyle and the 15D HRQoL questionnaire. The follow-up mRS was defined in 2016 using the electronic patient registry and the questionnaire data. The 15D profiles of each mRS grade were compared to those of the general population and to each other, using ANCOVA with age and sex standardization. Results Patients in mRS 0 (mean 15D score = 0.954 ± 0.060) had significantly better HRQoL than the general population (mean = 0.927 ± 0.028), p < 0.0001, whereas patients in mRS 1–4 had worse HRQoL than the general population, p < 0.0001. Patients in mRS 1 (mean = 0.844 ± 0.100) and mRS 2 (mean = 0.838 ± 0.107) had a similar HRQoL. In the recently published AVM research, the most commonly used cut points for mRS dichotomization were between mRS 1 and 2 and between mRS 2 and 3. Conclusions Using 15D, we were able to find significant differences in the HRQoL between mRS 0 and mRS 1 AVM patients, against the recent findings on stroke patients using EQ-5D in their analyses. Although the dichotomization cut point is commonly set between mRS 1 and 2, patients in these grades had a similar HRQoL and a decreased ability to continue their premorbid lifestyle, in contrast to patients in mRS 0.

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Outcome of Microsurgery for Arteriovenous Malformations in a Resource-Restricted Environment: Single-Surgeon Series from Vietnam

Cited by 8 publications

References 14 publications

A system divided: the state of neurosurgical training in modern-day Vietnam

A system divided: the state of neurosurgical training in modern-day Vietnam

Microsurgery for a ruptured intracranial aneurysm in a 3-year-old child: A case report

Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls

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