Tran Van Dinh, Nguyen Bac Thanh, Van Dong He, Lieber Bryan A, Bista Jehan, Van Vu Hoe, Bui Tien Ngoc, Chu Hung Thanh, Nguyen Phuong Xuan, Nguyen Tuan Anh, Ono Tomonori, Trieu Sang Tien, Nhu Son Dinh
Vietnam Military Medical University, Hanoi, Vietnam; Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam.
Vietnam Military Medical University, Hanoi, Vietnam.
World Neurosurg. 2023 Oct;178:e559-e565. doi: 10.1016/j.wneu.2023.07.119. Epub 2023 Aug 1.
Epilepsy surgery is traditionally difficult to pursue in resource-limited countries but is nevertheless essential in the treatment of medication-refractory, surgically amenable epilepsy.
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.
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.
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.
在资源有限的国家，传统上开展癫痫手术困难重重，但对于药物难治性、适合手术治疗的癫痫患者而言，癫痫手术至关重要。
在国际合作的帮助下，越南启动了一项成功的癫痫项目。本文对2018年5月至2022年9月在越南德医院接受颞叶切除术的35例单侧药物难治性颞叶癫痫患者进行回顾性病历审查，并结合前瞻性长期随访。
男女比例为0.6:1，意识障碍性局灶性发作的患者占97.14%。在局灶性有意识发作的患者中，51.41%为局限性发作，通过脑电图检测到。术后，80%的患者在1年时无癫痫发作（恩格尔I级），其余20%的患者癫痫发作有显著改善（恩格尔II级）。术后颞叶病理分类如下：内侧颞叶硬化（48.57%）、局灶性皮质发育不良（25.71%）和低级别肿瘤（25.71%）。17.14%的患者有术后并发症（5例感染和1例短暂性肢体轻瘫），无死亡病例。
即使在资源匮乏的环境中，也可为颞叶疾病引起的药物难治性癫痫提供有效且安全的手术治疗。本研究为资源匮乏环境中的未来医院提供了国际合作与支持的典范以供效仿。
