Objective Brain mapping with direct electrical stimulation is considered the gold standard for maximum, safe resection of tumors affecting eloquent regions. However, no consensus exists in selection and interpretation of intraoperative testing for language and other cognitive domains. Our aim was to capture and statistically analyze variability in current practices in intraoperative language testing among neurosurgeons and neuropsychologists in the United States, Europe and rest of the world. https://www.selleckchem.com/products/d609.html Methods An electronic questionnaire was developed by a multidisciplinary team at Queen Square, London, and distributed internationally through selected organized societies. The survey included two domains terminology and common understanding of clinical deficits and selection of intraoperative tests used per specific brain region. Participants stratified by specialty, years of experience, and monthly caseload. Data were analyzed using Krippendorff's α, Wilcoxon rank sum test and Kruskal-Wallis analysis of variance. Results A total of 137 specialists participated. A low agreement was recorded for each of the 20 questions (Krippendorff's α=-0.023-0.312). Further subgroup analysis revealed low inter-rater reliability (IRR) independent of specialism, neurosurgeons (α=0.013-0.318) compared to non-neurosurgeons (α=-0.021-0.398; p=0.808) and years of experience, less then 1 years (α=-0.003-0.282), 2-5 years (α=0.009-0.327), 6-10 years (α=0.003-0.234) and over 10 years (α=-0.003-0.372; p=0.200). Conclusions The current study documents high interrater variability, regardless of specialism and years of experience in the cohort of neurosurgeons and language specialists surveyed, and may be applicable to much wider group of specialists, indicating the need to reduce inter-observer, inter-institutional and inter-specialty variability, reach consensus, and increase the validity, interpretation and predictive power of intraoperative mapping.Background Mechanical thrombectomy has become the standard treatment for acute ischemic stroke caused by large vessel occlusion; however, refractory occlusions still exist despite various thrombectomy procedures. The double stent-retriever (SR) technique, which utilizes not a single, but two SRs simultaneously at the occlusion, can be useful for such refractory occlusions. Methods We described two cases of refractory acute cerebral occlusion despite the use of conventional thrombectomy procedures, which were both treated with the double SR technique. To discuss the technical aspects of how this easy-to-perform technique facilitates the device-clot interaction, we also evaluated radiographic findings of the SR's strut during the procedure. Results In both cases, conventional thrombectomy procedures, including an SR alone, an aspiration catheter alone, and combined use of the SR and aspiration catheter failed to recanalize the occlusion. Then, the double SR technique was performed with the stent-in-stent method in one patient and the parallel stent method in the other patient. One pass of this technique retrieved hard clots and successfully recanalized the refractory occlusion in both cases. Intraprocedural radiographical images of these cases showed that the degree of stent expansion improved after deployment of the second SR compared with the first one. Conclusions Our radiographical findings suggested that adding one more SR facilitates the device-clot interaction at the occlusion site. The double SR technique may be an easy-to-perform thrombectomy technique to improve the clot-capturing ability for the management of refractory acute cerebral artery occlusions.Objective To evaluate the differences in surgical outcomes of patients with cervical spondylotic myelopathy with and without congenital cervical spinal stenosis (CCSS). Methods Institutional review board approval was obtained to conduct a retrospective chart review of patients with cervical spondylotic myelopathy who underwent decompression and fusion surgeries from 2010-2016 at a single institution. CCSS was identified using the Torg-Pavlov ratio on lateral cervical radiographs. Pre- and postoperative outcome measures were assessed using the modified Japanese Orthopedic Association (mJOA) and the EuroQol 5-dimension questionnaire (EQ-5D). Results Of 208 patients, Torg-Pavlov ratio identified 85 patients with CCSS. There were no significant differences between the CCSS patient and control patient groups in EuroQol 5-dimension questionnaire and mJOA scores at all 4 designated time points in the study (preoperative, earliest postoperative, 6 month postoperative, and 1 year postoperative). Although not statistically significantly, there was a notable trend for patients with CCSS to be less likely to have mJOA-defined severe myelopathy at the postoperative (odds ratio [OR], 0.75; P = 0.38), 6 month postoperative (OR, 0.66; P = 0.20), and 1 year postoperative (OR, 0.64; P = 0.14) time points. Conclusions Postoperatively, compared with non-CCSS patients, patients with congenital cervical stenosis reported equal quality of life for all markers. Our findings suggest that in patients with CCSS and relatively mild symptoms of myelopathy, equal consideration should be given for surgical intervention. The findings of this study warrant further large-scale, multi-institutional investigation to further understand the generalizability of these surgical outcome results.Purpose Lumbosacral lipomas (LSLs), one form of closed spinal dysraphism, are congenital disorders of the terminal spinal cord (sc). Delayed neurological deterioration often occurs in the subsequent developmental course of the patient. Identifying the cellular and molecular factors underlying the progressive damage to neural structures is a prerequisite for developing treatment strategies for LSLs. Methods Nine LSL specimens obtained from the sc/lipoma interface during surgical resection were examined. Normal sc tissue served as a control. Clinical characteristics were obtained, and spinal MRI was re-evaluated. Cellular marker profiles were established. Immunoreactivity (IR) of HIF-1a/-2a, EPO/EPOR, IL-1b/IL-1R1, and TNFa/TNF-R1 was analyzed qualitatively and semiquantitatively by densitometry. Colabeling with cellular markers was determined by multifluorescence labeling. Cytokines were further analyzed by real-time RT-PCR. Results LSL specimens exhibited significant gliosis. HIF-1a/-2a IR and EPO/EPR IR were found at significantly higher levels in the LSL specimens, as were IL-1b-/IL1-R1 IR and TNFa-/TNF-R IR (p less then 0.