Surgical treatment of epilepsy in Vietnam: program development and international collaboration

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The purpose of this report was to describe an international collaboration model to facilitate the surgical treatment of children with epilepsy in Vietnam.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This model uses three complementary methods to achieve a meaningful expansion in epilepsy surgery capacity: US-based providers visiting Hanoi, Vietnam; Vietnamese providers visiting the US; and ongoing telecollaboration, including case review and real-time mentorship using internet-based communication platforms.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Introductions took place during a US neurosurgeon’s visit to Vietnam in 2014. Given the Vietnamese surgeon’s expertise in intraventricular tumor surgery, the focus of the initial visit was corpus callosotomy. After two operations performed jointly, the Vietnamese surgeon went on to perform 10 more callosotomy procedures in the ensuing 6 months with excellent results. The collaborative work grew and matured in 2016–2017, with 40 pediatric epilepsy surgeries performed from 2015 through 2017. Because pediatric epilepsy care requires far more than neurosurgery, teams traveling to Vietnam included a pediatric neurologist and an electroencephalography (EEG) technologist. Also, in 2016–2017, a neurosurgeon, two neurologists, and an EEG nurse from Vietnam completed 2- to 3-month fellowships at Children’s of Alabama (COA) in the US. These experiences improved EEG capabilities and facilitated the development of intraoperative electrocorticography (ECoG), making nonlesional epilepsy treatment more feasible. The final component has been ongoing, i.e., regular communication. The Vietnamese team regularly sends case summaries for discussion to the COA epilepsy conference. Three patients in Vietnam have undergone resection guided by ECoG without the US team present, although there was communication via internet-based telecollaboration tools between Vietnamese and US EEG technologists. To date, two of these three patients remain seizure free. The Vietnamese team has presented the results of their epilepsy experience at two international functional and epilepsy surgery scientific meetings.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Ongoing international collaboration has improved the surgical care of epilepsy in Vietnam. Experience suggests that the combination of in-country and US-based training, augmented by long-distance telecollaboration, is an effective paradigm for increasing the capacity for highly subspecialized, multidisciplinary neurosurgical care.</jats:p></jats:sec>

Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam

“…The details and growth of the partnership between our two centers has been described previously. 14 In our series 16 patients received a surgical intervention, with half obtaining at least 75% improvement in their seizure frequency, and nearly all (15 [93.7%] of 16) reducing their seizures by at least 50%. An analogous series by Kwan et al in Taiwan demonstrated significant improvement in seizure burden ranging from 58.6% to 82.1% of patients, depending on preoperative seizure semiology.…”

“…The details of this partnership have been previously published and are discussed at length elsewhere. 14 All surgical procedures in this case series, other than the first 2, were performed independently by the first author and his surgical team at the National Cancer Hospital. We present here the details of the patients selected for intervention and their outcomes in this initial case series.…”

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

“…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.…”

International electives in neurological surgery training: a survey of program directors from Accreditation Council for Graduate Medical Education–approved neurological surgery programs

“…A truly impactful intervention in these countries needs to be consistent and include the development of programs and practitioners. [4][5][6] Moreover, such programs should be thoughtfully embedded in a larger framework that incorporates a more comprehensive approach to improving surgical care, one that includes consideration of not just workforce but also other factors, such as financing and infrastructure. 7 In order to begin addressing these needs, a significant surgical workforce from high-income nations would be necessary to provide long-term and consistent aid.…”