Thai Journal of Neurological Surgery

Seizure Outcome after Surgical Treatment for Temporal Lobe Epilepsy with Hippocampal Sclerosis

Tanatkan Kumpanont, Teeradej Srikijvilaikul — Sun, 05 Oct 2025 00:00:00 +0700

Objective: To study seizure outcomes in patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) and predictive factors associated with seizure outcome.
Material and Methods: One hundred and forty-seven patients with drug-resistance temporal lobe epilepsy with hippocampal sclerosis were retrospectively reviewed at Neurological Institute of Thailand between 2011 and 2021. All patients underwent temporal lobectomy and had pathologically proven hippocampal sclerosis. A minimum follow-up period was two years and seizure outcomes were classified as being seizure free and not seizure free using Engel’s classification.
Results: A total of 109 patients were included in the study, there were 47 males and 62 females. The median follow-up duration was 4 years. Long-term seizure freedom at 2 years was 86.2% and at 5 years was 85.1%. Overall, 93 (85.3%) patients were seizure free (Engel I) at their last follow-up. Ninetyfour (86.2%) patients were seizure free at a minimum of two years after surgery. Thirty-four patients were able to discontinue anti-seizure medication. There was 14% morbidity rate with no mortality. No predictive factors were found associated with seizure outcome in this study.
Conclusion: Temporal lobectomy is effective in drug-resistant temporal lobe epilepsy with hippocampal sclerosis. Favorable seizure free outcomes at least two years can be achieved. However, there are no predictive factors associated with seizure outcome in this study.

Long Term Outcome for Surgical Resection of Pediatric Spinal Lipoma in Kcmh: 20 Years Experience

Prem Kamolamnuaykit, Kusawadee Juengsirakulwit, Jiraphorn Amornfa — Sun, 05 Oct 2025 00:00:00 +0700

Background: The optimal surgical approach for spinal lipoma remains controversial, particularly in asymptomatic patients. Factors contributing to an increased risk of TCS require further investigation.
Objective: This study aims to analyze the long-term outcomes of patients with spinal lipoma who underwent surgery at King Chulalongkorn Memorial Hospital and identify factors associated with an increased risk of developing TCS.
Methods: A survival analysis was conducted on pediatric patients with spinal lipoma who underwent surgery at King Chulalongkorn Memorial Hospital. Data were retrospectively reviewed for patients who underwent surgery between September 2003 and September 2023 (20 years).
Results: Among 69 patients with a mean follow-up period of 9.6 years, the mean time to progression was 15.7 years, with a progression-free survival (PFS) rate of 84.1% at 19years. The time to retethering ranged from 2 to 17 years after the initial surgery. When analyzing risk factors for TCS, asymptomatic patients had a PFS of 86.7%, while symptomatic patients had a PFS of 79.2%, with no statistically significant difference (p = 0.519). The PFS rates for different spinal lipoma types were as follows: dorsal (50%), transitional (78.6%), chaotic (94.4%), and terminal (89.5%), with no significant difference (p = 0.157). In terms of the extent of resection, patients who underwent complete or near-total resection had a PFS of 94.7%, while those who underwent partial resection had a PFS of 77.3%, with no significant difference (p = 0.071). However, when stratified by cord-sac ratio, PFS rates were 100% for < 0.3, 92.7% for 0.3–0.5, and 50% for > 0.5, demonstrating statistical significance (p = 0.002).
Conclusion: The long-term outcomes of spinal lipoma patients who underwent surgery at King Chulalongkorn Memorial Hospital showed a PFS rate of 84.1%. The cord-sac ratio was the only significant factor associated with an increased risk of developing TCS.

Long-term Outcomes and Complications of Multilevel ACDF, Compared with Single-level ACDF, A Retrospective Study

Anusorn Kuruvanich, Ekkapot Jitpun, Teera Tangviriyapaiboon — Sun, 05 Oct 2025 00:00:00 +0700

Objective: To compare the clinical outcomes, radiological parameters, and complication incidence of patients who underwent anterior cervical discectomy and fusion (ACDF) to prove our hypothesis that multilevel ACDF did not have higher rate of complication than single level or 2-level ACDF.
Methods: We conducted a retrospective review of 82 consecutive patients who underwent ACDF for treatment of cervical spondylosis at Neurological Institute of Thailand in 10 years (2006 – 2015) by single surgeon. Patients were divided into 3 group (1-level, 2-level and 3 or 4 level ACDF). The clinical courses, fusion rate, postoperative complications, and radiographical adjacent-level changes regarding each group were evaluated.
Results: There is no statistical difference in restoration of cervical lordosis, and incidence of postoperative early and late complications between 1-level ACDF, 2-level ACDF and 3 or 4-level ACDF groups (P > 0.05). The 3 or 4-level ACDF group had more bleeding (P = 0.000) and longer length of stay in hospital (p = 0.002), with no clinically significant. Subgroup analysis of 3-level ACDF and 4-level ACDF had no statistical differences in all categories.
Conclusion: This study showed that result of multilevel ACDF was not different from 1 or 2-level ACDF in all outcome parameters. Compared to previous systematic review of posterior approach, this study does not show different results and complications. Multilevel ACDF had no higher risk of surgery in comparison to 1 or 2-level ACDF.

Efficacy of a Rapid External Ventricular Drain (EVD) Weaning Protocol in Preventing EVD Associated Complications

Tue, 16 Dec 2025 00:00:00 +0700

Background: External ventricular drainage (EVD) is a temporary management in patients with acute obstructive hydrocephalus from various causes. However, prolonged EVD placement is associated with significant risk of EVD-associated complications. To mitigate these risks and expedite the weaning process, a rapid external ventricular drainage weaning protocol has been proposed as a potential solution. This research aims to evaluate the efficacy of such a weaning protocol in preventing EVD-associated complications and improving patient outcomes. Methods: Between January 2020 and December 2023, a prospective cohort study was conducted in patients who underwent EVD placement. The rapid EVD weaning protocol was assigned in the cohort group. The rate of EVD-associated complications was compared to the historical control group. Results: Sixty patients were divided into rapid or gradual EVD-weaning groups (n = 30 each). EVD-related infection and complications occurred in 3.3% vs 10%; p = 0.612 and 23.3% and 40.0%: p = 0.258 in the rapid and gradual groups, respectively. Secondary outcomes—VP shunt rate, hospital length of stay, ICU stay, and EVD duration—did not differ significantly between groups. Only EVD-weaning duration was shorter with rapid weaning (4.4 vs 7.61 days; p=0.002). Conclusion: The results indicate that rapid EVD weaning may shorten the weaning process without adversely affecting clinical outcomes or increasing complication rates. Confirmation in larger, adequately powered studies with extended follow-up is needed to define its role in neurocritical care.

5-year recurrent rate and factors related recurrent spinal meningioma

Patipat Pirunrungruang, Luckchai Phonwijit — Tue, 09 Dec 2025 00:00:00 +0700

Introduction: Spinal meningiomas are usually benign spinal cord tumors, representing about 25% of all spinal tumors. Treatment options include watchful waiting and surgery, which typically removes the tumor completely with a low recurrence risk. However, undetected recurrences can cause neurological issues, necessitating regular MRI scans. Previous studies showed a 7-9% recurrence rate at 5 years post- surgery, increasing to 20-25% after 10 years3. This study aims to find 5-year recurrence rate and related factors for recurrence. Methods: The authors conducted a single-center retrospective descriptive study in patients with spinal meningiomas treated in Siriraj hospital from July 2006 to November 2024. Finding 5-year and overall recurrence rate of 66 spinal meningiomas and related factors for recurrence. Results: 5-year and overall recurrence rates were 10.6% and 24.2%, respectively. The factors mostly affected recurrence were younger age at diagnosis (esp. <45 years) and history of neurofibromatosis type 2 (NF2). Other factors included gender, volume, location of tumor, dural tail sign, histopathological diagnosis and intra-operative finding did not showed statistically significance for tumor recurrence. Conclusions: The study at Siriraj Hospital shows that surgical removal of spinal meningiomas is effective but has a significant risk of recurrence, especially in younger patients or those with NF2. Despite benign nature of disease, our findings emphasize the importance of careful surgery and long-term follow-up. High-risk groups may need early and more frequent investigation.