Brain fracture discovered after nearly 30 years

Ho Chi Minh City Ms. Ngoc, 28 years old, often has sudden seizures, epilepsy treatment for more than 8 years was ineffective, the doctor examined and discovered a congenital brain defect.

3 Tesla MRI scan results showed that the patient's brain had a large fissure (2-5 cm wide depending on location), extending from the cerebral cortex to the ventricles, located on the right cerebral hemisphere.

On November 10, Master, Doctor, II Chu Tan Si, Head of the Department of Neurosurgery, Tam Anh General Hospital, Ho Chi Minh City, said that the patient had a brain fracture since childhood but did not know it. Now the fracture has expanded, causing severe epilepsy and convulsions. For the past 8 years, the patient has been treated for seizures and epilepsy with the highest dose of medication but with no results.

Brain fissure is a congenital malformation with an incidence of about 1/100,000 people, caused by a neuronal migration disorder, according to Dr. Tan Si. The fissure changes the circulation of cerebrospinal fluid. In normal people, cerebrospinal fluid flows from the lateral ventricle to the third and fourth ventricles, then to the cerebrospinal fluid cavity around the brain. When a large brain fissure appears, cerebrospinal fluid flows directly from the lateral ventricle through the brain fissure and to the cerebrospinal fluid cavity, skipping some necessary stages.

According to Dr. Si, people with small brain defects can adapt and live normally. In Ms. Ngoc's case, the crack expanded over time, causing cerebrospinal fluid to flow in, increasing intracranial pressure, compressing the surface of the cerebral cortex, causing epileptic seizures. The optimal solution is decompression surgery, followed by continued monitoring and treatment of epilepsy.

Brain MRI shows a large brain fissure filled with cerebrospinal fluid (white area). Photo: Provided by the hospital — Brain MRI shows a large brain fissure filled with cerebrospinal fluid (white area). Photo: *Provided by the hospital*

The surgeon performs endoscopic decompression of the intracranial space, placing a specialized plastic tube into the cleft of the brain and passing it down to the peritoneal cavity under the abdomen. On the tube there is an automatic valve that helps maintain a moderate amount of cerebrospinal fluid, stabilizing intracranial pressure. When the cerebrospinal fluid in the cleft increases, increasing intracranial pressure, the tube automatically unlocks to allow the cerebrospinal fluid to flow down to the peritoneal cavity. When the cerebrospinal fluid decreases, the valve automatically locks, preventing the cerebrospinal fluid from decreasing too much.

After three days of surgery, the patient's health is stable, recovering well, and is expected to be discharged after 5 days.

Surgeons perform cerebral decompression surgery on a patient. Photo: Provided by the hospital — Surgeons perform cerebral decompression surgery on a patient. Photo: *Provided by the hospital*

Dr. Tan Si said that patients need to take anti-epileptic drugs at appropriate doses. Doctors monitor changes in cerebrospinal fluid and intracranial pressure, epileptic waves for 2-6 months and adjust anti-epileptic drug prescriptions accordingly. The goal is to switch from polytherapy to monotherapy, from taking anti-epileptic drugs at the highest dose to the lowest dose, helping patients gradually improve their health and quality of life.

Truong Giang

* Patient's name has been changed

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