1
|
Nguyen BT, Huynh CT, Nguyen TM, Nguyen VT, Karras CL, Huynh-Le P, Tran HM. Gamma Knife radiosurgery for brain arteriovenous malformations: a 15-year single-center experience in Southern Vietnam. World Neurosurg 2022; 163:71-79. [DOI: 10.1016/j.wneu.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
|
2
|
Can DDT, Lepard JR, Anh NM, Tuan PA, Tuan TD, Son VT, Grant JH, Johnston JM. Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship. J Neurosurg Pediatr 2021; 28:508-515. [PMID: 34450594 DOI: 10.3171/2021.5.peds20932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children's Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.
Collapse
Affiliation(s)
- Dang Do Thanh Can
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.,2Neurosurgical Department, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Jacob R Lepard
- 3Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,4Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama; and
| | - Nguyen Minh Anh
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Pham Anh Tuan
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tran Diep Tuan
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Vo Tan Son
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - John H Grant
- 5Department of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Johnston
- 3Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,4Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama; and
| |
Collapse
|
3
|
Kanmounye US, Sebopelo LA, Keke C, Zolo Y, Senyuy WP, Endalle G, Takoukam R, Sichimba D, Nguembu S, Ghomsi N. Mapping Global Neurosurgery Research Collaboratives: A Social Network Analysis of the 50 Most Cited Global Neurosurgery Articles. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTSocial network analysis of bibliometric data evaluates the relationships between the articles, authors, and themes of a research niche. The network can be visualized as maps composed of nodes and links. This study aimed to identify and evaluate the relationships between articles, authors, and keywords in global neurosurgery. The authors searched global neurosurgery articles on the Web of Science database from inception to June 18, 2020. The 50 most cited articles were selected and their metadata (document coupling, co-authorship, and co-occurrence) was exported. The metadata were analyzed and visualized with VOSViewer (Centre for Science and Technology Studies, Leiden University, The Netherlands). The articles were published between 1995 and 2020 and they had a median of 4.0 (interquartile range [IQR] = 5.0) citations. There were 5 clusters in the document coupling and 10 clusters in the co-authorship analysis. A total of 229 authors contributed to the articles and Kee B. Park contributed the most to articles (14 publications). Backward citation analysis was organized into 4 clusters and co-occurrence analysis into 7 clusters. The most common themes were pediatric neurosurgery, neurotrauma, and health system strengthening. The authors identified trends, contributors, and themes of highly cited global neurosurgery research. These findings can help establish collaborations and set the agenda in global neurosurgery research.
Collapse
Affiliation(s)
| | - Lorraine Arabang Sebopelo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chiuyu Keke
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Zambia, Lusaka, Zambia
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Genevieve Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Régis Takoukam
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- School of Medicine, Copperbelt University, Kitwe, Zambia
| | - Stéphane Nguembu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nathalie Ghomsi
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
| |
Collapse
|
4
|
Haji FA, Lepard JR, Davis MC, Lien ND, Can DDT, Hung CV, Thang LN, Rocque BG, Johnston JM. A model for global surgical training and capacity development: the Children's of Alabama-Viet Nam pediatric neurosurgery partnership. Childs Nerv Syst 2021; 37:627-636. [PMID: 32720077 DOI: 10.1007/s00381-020-04802-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Training capable and competent neurosurgeons to work in underserved regions of the world is an essential component of building global neurosurgical capacity. One strategy for achieving this goal is establishing longitudinal partnerships between institutions in low- and middle-income countries (LMICs) and their counterparts in high-income countries (HICs) utilizing a multi-component model. We describe the initial experience of the Children's of Alabama (COA) Global Surgery Program partnership with multiple Vietnamese neurosurgical centers. METHODS The training model developed by the COA Global Surgery Program utilizes three complementary and interdependent methods to expand neurosurgical capacity: in-country training, out-of-country training, and ongoing support and mentorship. Multiple Vietnamese hospital systems have participated in the partnership, including three hospitals in Hanoi and one hospital in Ho Chi Minh City. RESULTS During the 7 years of the partnership, the COA and Viet Nam teams have collaborated on expanding pediatric neurosurgical care in numerous areas of clinical need including five subspecialized areas of pediatric neurosurgery: cerebrovascular, epilepsy, neuroendoscopy for hydrocephalus management, craniofacial, and neuro-oncology. CONCLUSION Long-term partnerships between academic departments in LMICs and HICs focused on education and training are playing an increasingly important role in scaling up global surgical capacity. We believe that our multi-faceted approach consisting of in-country targeted hands-on training, out-of-country fellowship training at the mentor institution, and ongoing mentorship using telecollaboration and Internet-based tools is a viable and generalizable model for enhancing surgical capacity globally.
Collapse
Affiliation(s)
- Faizal A Haji
- Division of Neurosurgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada. .,Department of Surgery, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Jacob R Lepard
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - Matthew C Davis
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - Nguyen Duc Lien
- Department of Neurosurgery, Viet Nam National Cancer Hospital, Hanoi, Vietnam
| | - Dang Do Thanh Can
- Department of Neurosurgery, Children's Hospital #2, Ho Chi Minh City, Vietnam
| | - Cao Vu Hung
- Department of Neurology, Viet Nam National Chrildren's Hospital, Hanoi, Vietnam
| | - Le Nam Thang
- Department of Neurosurgery, Viet Nam National Children's Hospital, Hanoi, Vietnam
| | - Brandon G Rocque
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - James M Johnston
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| |
Collapse
|
5
|
Jean WC, Huynh T, Pham TA, Ngo HM, Syed HR, Felbaum DR. A system divided: the state of neurosurgical training in modern-day Vietnam. Neurosurg Focus 2020; 48:E2. [PMID: 32114556 DOI: 10.3171/2019.12.focus19800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- Walter C Jean
- 1Department of Neurosurgery, George Washington University, Washington, DC.,7Global Brainsurgery Initiative, Washington, DC
| | - Trong Huynh
- 2Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.,3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Tuan A Pham
- 4Department of Neurosurgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hung M Ngo
- 3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Hasan R Syed
- 5Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.,7Global Brainsurgery Initiative, Washington, DC
| | - Daniel R Felbaum
- 6Department of Neurosurgery, Georgetown University Hospital, Washington, DC; and.,7Global Brainsurgery Initiative, Washington, DC
| |
Collapse
|
6
|
Deora H, Garg K, Tripathi M, Mishra S, Chaurasia B. Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education. Neurosurg Focus 2020; 48:E11. [DOI: 10.3171/2019.12.focus19852] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe evolution of the neurosurgical specialty in lower-middle-income countries is uniformly a narrative of continuous struggle for recognition and resource allocation. Therefore, it is not surprising that neurosurgical education and residency training in these countries is relatively nascent. Dr. Harvey Cushing in 1901 declared that he would specialize in neurosurgery and gave his greatest contribution to the advancement of neurosurgical education by laying the foundations of a structured residency training program. Similar efforts in lower-middle-income countries have been impeded by economic instability and the lack of well-established medical education paradigms. The authors sought to evaluate the residency programs in these nations by conducting a survey among the biggest stakeholders in these educational programs: the neurosurgical residents.METHODSA questionnaire addressing various aspects of the residency program from a resident’s perspective was prepared with Google Forms and circulated among neurosurgery residents through social media and email groups. Where applicable, a 5-point Likert scale was used to grade the responses to the questions. Responses were collected from May to October 2019 and analyzed using descriptive statistics. Complete anonymity of the respondents was ensured to keep the responses unbiased.RESULTSA total of 195 responses were received, with 189 of them from lower-middle-income countries (LMICs). The majority of these were from India (75%), followed by Brazil and Pakistan. An abiding concern among residents was lack of work hour regulations, inadequate exposure to emerging subspecialties, and the need for better hands-on training (> 60% each). Of the training institutions represented, 89% were offering more than 500 major neurosurgical surgeries per year, and 40% of the respondents never got exposure to any subspecialty. The popularity of electronic learning resources was discernible and most residents seemed to be satisfied with the existent system of evaluation. Significant differences (p < 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.CONCLUSIONSIt is prudent that concerned authorities in LMICs recognize and address the deficiencies perceived by neurosurgery residents in their training programs. A determined effort in this direction would be endorsed and assisted by a host of international neurosurgical societies when it is felt that domestic resources may not be adequate. Quality control and close scrutiny of training programs should ensure that the interests of neurosurgical trainees are best served.
Collapse
Affiliation(s)
- Harsh Deora
- 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Kanwaljeet Garg
- 2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjul Tripathi
- 3Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Shashwat Mishra
- 2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bipin Chaurasia
- 4Department of Neurosurgery, Bangladesh State Medical University, Dhaka, Bangladesh
| |
Collapse
|
7
|
Duc Lien N, Tuan DA, Vu Hung C, Lepard JR, Rocque BG. Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam. J Neurosurg Pediatr 2020; 25:582-587. [PMID: 32109876 DOI: 10.3171/2019.12.peds19638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postoperative seizure outcome in children with drug-resistant epilepsy not eligible for focal resection who underwent corpus callosotomy. METHODS The study included 16 patients undergoing corpus callosotomy between September 2015 and May 2018. Seizure semiology and frequency, psychomotor status, and video electroencephalography and imaging findings were evaluated for all patients. RESULTS Of the 16 patients who underwent callosotomy during the study period, 11 underwent complete callosotomy and 5 underwent anterior only. Seizure improvement greater than 75% was achieved in 37.5% of patients, and another 50% of patients had seizure improvement of 50%-75%. No sustained neurological deficits were observed in these patients. There were no significant complications. Duration of postoperative follow-up ranged from 12 to 44 months. CONCLUSIONS Corpus callosotomy is an effective treatment for selected patients with drug-resistant epilepsy not eligible for focal resection in resource-limited settings. Fostering and developing international epilepsy surgery centers should remain a high priority for the neurosurgical community at large.
Collapse
Affiliation(s)
- Nguyen Duc Lien
- 1Neurosurgical Department, Vietnam National Cancer Hospital, Hanoi
| | - Dang Anh Tuan
- 2Neurology Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Cao Vu Hung
- 2Neurology Department, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
- 4The Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Brandon G Rocque
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| |
Collapse
|
8
|
Can DDT, Lepard JR, Tri TT, Van Duong T, Thuy NT, Thach PN, Johnston JM, Oakes WJ, Dong A T. The growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report. J Neurosurg Pediatr 2020; 25:445-451. [PMID: 31952040 DOI: 10.3171/2019.11.peds19291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/14/2019] [Indexed: 11/06/2022]
Abstract
Conjoined twins are a rare congenital abnormality with an estimated incidence of 1:50,000 pregnancies and 1:200,000 live births. Pygopagus twins are characterized by sacrococcygeal fusion that is commonly associated with perineal and spinal abnormalities. Management of this complex disease requires a well-developed surgical system with multidisciplinary capacity and expertise.A decade ago there were no dedicated pediatric neurosurgeons in southern Vietnam. This has changed within a few short years; there are now 10 dedicated pediatric neurosurgeons with continually expanding technical capacity. In August 2017 a multidisciplinary surgical and anesthetic team successfully separated female pygopagus twins with fused sacrum and spinal cord with associated myelomeningocele defect.The authors present here the first successful separation of pygopagus twins in Vietnam as a representative case of gradual and sustainable pediatric neurosurgical scale-up.
Collapse
Affiliation(s)
- Dang D T Can
- 1Neurosurgical Department, Children's Hospital 2, and
- 9University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Jacob R Lepard
- 1Neurosurgical Department, Children's Hospital 2, and
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 8Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Tran T Tri
- 4Pediatric Surgery Department, Children's Hospital 2, Ho Chi Minh City
| | - Tran Van Duong
- 5Plastic Surgery Department, Cho Ray Hospital, Ho Chi Minh City
| | | | - Pham N Thach
- 7Urology Department, Children's Hospital 2, Ho Chi Minh City, Vietnam; and
| | - James M Johnston
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 3Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - W Jerry Oakes
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 3Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - Tran Dong A
- 4Pediatric Surgery Department, Children's Hospital 2, Ho Chi Minh City
| |
Collapse
|
9
|
Neurosurgical Oncology in Vietnam. World Neurosurg 2019; 127:541-548. [PMID: 30902769 DOI: 10.1016/j.wneu.2019.03.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In conjunction with Vietnam's unparalleled economic growth over the past 20 years, our scope of neurosurgical interventions has considerably diversified throughout this time period. METHODS Although still appreciably limited, healthcare resources and infrastructure have expanded and shifted the focus within neurosurgery at Ho Chi Minh City's Cho Ray Hospital from head trauma (which remains highly prevalent) to an equal proportion of elective cases for vascular lesions, tumors, and degenerative spine disease. Arguably the most significant progress throughout the new millennium has been achieved in the realm of neurosurgical oncology. RESULTS About 1000 craniotomies are performed annually for brain tumors at our institution, most of which are for lower-grade lesions that result in excellent surgical outcomes. We continue to strive to improve the standard of care for patients with malignant brain tumors, as the first multidisciplinary neuro-oncology care team was founded recently in 2016. CONCLUSIONS This article is the first in the English neurosurgical literature to report on the current state and outcomes of neuro-oncology in Vietnam, as we highlight our experiences in caring for patients with brain tumors at Cho Ray Hospital.
Collapse
|
10
|
Rocque BG, Davis MC, McClugage SG, Tuan DA, King DT, Huong NT, Thi Bich Van N, Kankirawatana P, Vu Hung C, Nam Thang L, Johnston JM, Duc Lien N. Surgical treatment of epilepsy in Vietnam: program development and international collaboration. Neurosurg Focus 2018; 45:E3. [DOI: 10.3171/2018.7.focus18254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this report was to describe an international collaboration model to facilitate the surgical treatment of children with epilepsy in Vietnam.METHODSThis 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.RESULTSIntroductions 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.CONCLUSIONSOngoing 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.
Collapse
Affiliation(s)
| | | | | | - Dang Anh Tuan
- 2Department of Neurology, Vietnam National Children’s Hospital
| | - Donald T. King
- 3Division of Neurology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Pongkiat Kankirawatana
- 3Division of Neurology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cao Vu Hung
- 2Department of Neurology, Vietnam National Children’s Hospital
| | - Le Nam Thang
- 4Department of Neurosurgery, Vietnam National Children’s Hospital, Dong Da District; and
| | | | - Nguyen Duc Lien
- 5Department of Neurosurgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
| |
Collapse
|
11
|
Carr C, Kahn L, Mathkour M, Biro E, Bui CJ, Dumont AS. The shifting burden of neurosurgical disease: Vietnam and the middle-income nations. Neurosurg Focus 2018; 45:E12. [DOI: 10.3171/2018.7.focus18297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. It has been particularly insightful for understanding disease demographics in middle-income nations undergoing rapid development, such as Vietnam, where 6 of the top 10 causes of death are relevant to the neurosurgeon. The burden of stroke—the number one cause of death in Vietnam—is particularly impressive. Likewise, road injuries, with a disproportionate rate of traumatic brain injury, continue to increase in Vietnam following economic development. Low-back and neck pain is the number one cause of disability. Simultaneously, more patients have access to care, and healthcare spending is increased.METHODSIt is imperative that neurosurgical capital and infrastructure keep pace with Vietnam’s growth. The authors searched the existing literature for assessments of neurosurgical infrastructure or initiatives to address neurosurgical disease burden. Using GBD data, the authors also abstracted data for death by cause and prevalence of years of life lost due to disability (YLD) for common neurosurgical pathologies for Vietnam and comparison nations.RESULTSInterventions aimed at primary prevention of risk factors for neurosurgical disease and focused on the transference of self-sustainable technical skills were found to be analogous to those that have been successful in other regions. Efforts toward stroke prevention have been focused on causal risk factors. Multiple investigators have found that interventions aimed at increasing helmet use were successful in preventing traumatic brain injury. Government-led reforms and equipment donation programs have improved technical capacity. Nevertheless, Vietnam lags behind other nations in neurosurgeons per capita; cause-attributable death and YLD attributable to neurosurgical disease are considerably higher in Vietnam and middle-income nations compared to both lower-income nations and upper-income nations.CONCLUSIONSMore than two-thirds of deaths attributable to neurosurgical pathologies in Vietnam and other middle-income nations were due to stroke, and one-fifth of both cause-attributable death and YLD was associated with neurosurgical pathologies. Vietnam and other middle-income nations continue to assume a global burden of disease profile that ever more closely resembles that of developed nations, with particular cerebrovascular, neurotrauma, and spinal disease burdens, leading to exponentially increased demand for neurosurgeons that threatens to outpace the training of neurosurgeons.
Collapse
Affiliation(s)
- Christopher Carr
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Lora Kahn
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Mansour Mathkour
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Erin Biro
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Cuong J. Bui
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Aaron S. Dumont
- 3Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana
| |
Collapse
|
12
|
Venturini S, Park KB. Evaluating the Effectiveness and the Impact of Donated Neurosurgical Equipment on Neurosurgical Units in Low- and Middle-Income Countries: The World Federation of Neurosurgical Societies Experience. World Neurosurg 2018; 109:98-109. [DOI: 10.1016/j.wneu.2017.09.117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
|