ed judiciously in multimodal treatment strategies involving SRS for appropriately selected large-volume or angioarchitecturally high-risk AVMs. Pre-SRS AVM embolization with Onyx does not appear to negatively influence outcomes after SRS. These analyses, based on de novo nidal characteristics, thereby refute previous studies that found detrimental effects of Onyx embolization on SRS-induced AVM obliteration. However, given the risks incurred by nidal embolization using Onyx, this neoadjuvant intervention should be used judiciously in multimodal treatment strategies involving SRS for appropriately selected large-volume or angioarchitecturally high-risk AVMs. The aim of this study was to analyze the differences between posterolateral and posteromedial approaches to pontine cavernous malformations (PCMs) in order to verify the hypothesis that a posterolateral approach is more favorable with regard to preservation of abducens and facial nerve function. The authors conducted a retrospective analysis of 135 consecutive patients who underwent microsurgical resection of a PCM. The vascular lesions were first classified in a blinded fashion into 4 categories according to the possible or only reasonable surgical access route. In a second step, the lesions were assessed according to which approach was performed and different patient groups and subgroups were determined. In a third step, the modified Rankin Scale score and the rates of permanent postoperative abducens and facial nerve palsies were assessed. The largest group in this series comprised 77 patients. Their pontine lesion was eligible for resection from either a posterolateral or posteromedial approach, in es in this series are substantially lower than those in the majority of other published reports. Competency-based medical education (CBME), an outcomes-based approach to medical education, continues to be implemented across many postgraduate medical education programs worldwide, including a recent introduction into Canadian neurosurgical training programs (July 2019). The success of this educational paradigm shift requires frequent faculty observation and evaluation of residents performing defined tasks of the specialty. A main challenge involves providing residents with frequent performance evaluations and feedback that are feasible for faculty to complete. This study aims to define what is currently happening and what changes are needed to make CBME successful for the certification of neurosurgeons' competence. A 55-item questionnaire was emailed nationwide to survey Canadian neurosurgical faculty. Fifty-two complete responses were received and achieved a distribution highly correlated with the number of faculty neurosurgeons practicing in each Canadian province (Pearson's r = 0.94). Two-thirds (er form (12%), an evaluation website (8%), or through a URL link sent via email (10%; p = 0.0032). To facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application. To facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application. Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared. This was a retrospective case series. https://www.selleckchem.com/products/smifh2.html From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patieny better than those of PDF for patients who could not walk preoperatively. The present study clearly indicated that the surgical outcomes of the authors' modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively. The goal of this study was to assess the success rate and complications of stereo-electroencephalogra-phy (sEEG) and laser interstitial thermal therapy (LITT) in the treatment of nonlesional refractory epilepsy in cingulate and insular cortex. The authors retrospectively analyzed the treatment response in 9 successive patients who underwent insular or cingulate LITT for nonlesional refractory epilepsy at their center between 2011 and 2019. Localization of seizures was based on inpatient video-EEG monitoring, neuropsychological testing, 3-T MRI, PET scan, magnetoencephalography scan, and/or ictal SPECT scan. Eight patients underwent sEEG, and 1 patient had implantation of both sEEG electrodes and subdural grids for localization of epileptogenic zones. LITT was performed in 5 insular cases (4 left and 1 right) and 3 cingulate cases (all left-sided). One patient also underwent both insular and cingulate LITT on the left side. All of the patients who underwent insular LITT as well as 2 of the 3 who underwent ula and cingulum should be evaluated more frequently for seizure onset zones. sEEG can be safely used to localize seizures originating from insular and cingulate cortex. LITT can successfully treat seizures arising from these deep-seated structures. The insula and cingulum should be evaluated more frequently for seizure onset zones. While maltreated children are at risk for recurrent maltreatment, less is known about the maltreatment recurrence of American Indian children in foster and adoptive homes. This study examined the recurrent maltreatment of American Indian children in foster and adoptive homes, specifically the physical, emotional, sexual, and spiritual abuse subtypes, as well as poly-victimization of American Indian children in comparison to their White peers. Data originated from the Experiences of Adopted and Fostered Individuals Project. The sample (n = 230) consisted of 99 American Indian and 131 White participants who experienced foster care and/or adoption during childhood. Chi-square analyses and a t-test were used to test differences in maltreatment recurrence. Ordinary least squares regression analysis was used to examine the factors that contributed to poly-victimization. Both American Indian and White participants reported high rates of emotional abuse. American Indian participants were particularly vulnerable to maltreatment recurrence in the forms of physical, sexual, and spiritual abuse, as well as poly-victimization in their foster and adoptive homes.