A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radio-surgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1-7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11-36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%-90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day-6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.

Previously described failure of global energy metabolism in HD was not confirmed. However, quantitative 1-hydrogen MRS and decoupled 31-phosphorus MRS are sensitive to +/-10% alterations in key cerebral metabolites, and may be of value in noninvasive monitoring of appropriate therapies.

1. Colonization in a reintroduced population of European beavers in the Loire Valley was studied between 1974 and 1999. It followed a discontinuous remoteness model and a scattered distribution, beavers occupying only 25% of the river system over the 2800 km explored. 2. After 5 years, the colonization rate reached 104.2% year–1 of new sites occupied (SD 75% year–1), before dropping over the next 20 years. Nevertheless, the number of new colonies per km (0.125) remained stable throughout the years. 3. Populus nigra, Salix alba and Fraxinus angustifolia were the dominant woody species in beaver sites, often associated with some herbaceous species. 4. The length of willow grove dominated by S. alba and P. nigra (x) was the best predictor of beaver home range (y), fitting the equation y=−0.742x + 5.9. Long‐term maintenance of the population requires a minimum of 1.79‐km of willows per colony. 5. In cutting tree trunks, beavers stimulate shoot development from the remaining stumps. They rejuvenate riparian forests, increase the number of tree stems and help stabilize the banks. Their effect on woody plant morphogenesis may have consequences for the helophyte communities used as food or habitat by other aquatic species.

Stereotactic radiosurgery under local anesthesia with the Leksell Gamma Knife can effectively treat some patients with recurrent tic douloureux after unsuccessful medical/surgical procedures. Seven of 12 patients have shown complete relief or improvement of their trigeminal neuralgia. No complications have been observed.

Although less effective than other stereotactic techniques, gamma knife radiosurgery for thalamotomy offers tremor control with minimal risk to patients unsuited for open surgery.