Introduction: Here we describe an international collaboration model to facilitate the surgical treatment of children with epilepsy in Vietnam.
Methods: This model uses three complementary methods to achieve a meaningful expansion in capacity: US-based providers visiting Hanoi, Vietnam; Vietnamese providers visiting the United States; and ongoing telecollaboration, including case review and real-time mentorship using internet-based communication platforms.
Results: Initial introductions took place during a visit by a US neurosurgeon 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 ten more callosotomy procedures in the ensuing six months with excellent results. Collaborative work matured in 2016-2017, with 40 pediatric epilepsy surgeries performed from 2015 through 2017. Because pediatric epilepsy care requires far more than neurosurgery, teams travelling to Vietnam included a pediatric neurologist and EEG technologist. Also, in 2016-17, a neurosurgeon, two neurologists, and an EEG nurse from Vietnam completed three-month fellowships at Children’s of Alabama in the US. These experiences improved EEG capabilities and facilitated the development of intraoperative electrocorticography, making non-lesional epilepsy treatment feasible. The final component has been ongoing, regular communication. The Vietnamese team sends case summaries for discussion at the COA epilepsy conference. Three patients have undergone resection, guided by ECoG, in Vietnam without the US team present, but communicating via internet-based telecollaboration tools between Vietnamese and US EEG technologists. Two of these three patients remain seizure free. The Vietnamese team has presented the results of their experience at two international functional and epilepsy surgery scientific meetings
Conclusions: Ongoing international collaboration has improved the surgical care of epilepsy in Vietnam. The combination of in-country and USA-based training, augmented by long-distance telecollaboration, is an effective paradigm for increasing capacity for highly subspecialized, multidisciplinary neurosurgical care
Patient Care: In low-resource settings, high-complexity surgical care requiring a multidisciplinary team poses particular challenges. In many cases of epilepsy surgery however, equipment needs are comparably modest, hospital stays short, and the long-term psychological and productivity impacts large. We suggest that epilepsy surgery should be considered alongside such interventions as endoscopic third ventriculostomy for hydrocephalus and craniotomy for acute extra-axial hematoma when discussing interventions worthy of early introduction to increase neurosurgical capacity in developing countries
Learning Objectives: 1) Demonstrate how multidisciplinary high-complexity surgical care teams can be successfully implemented in low-resource environments.
2) With the addition of relevant surgical skillsets, equipment, and neurology and EEG support, a large multidisciplinary epilepsy surgery center has been established in Viet Jam.