Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium.

Abstract Object The aim of this study was to evaluate the outcomes of Gamma Knife surgery (GKS) when used for patients with intractable cluster headache (CH). Methods Four participating centers of the North American Gamma Knife Consortium identified 17 patients who underwent GKS for intractable CH between 1996 and 2008. The median patient age was 47 years (range 26-83 years). The median duration of pain before GKS was 10 years (range 1.3-40 years). Seven patients underwent unsuccessful prior surgical procedures, including microvascular decompression (2 patients), microvascular decompression with glycerol rhizotomy (2 patients), deep brain stimulation (1 patient), trigeminal ganglion stimulation (1 patient), and prior GKS (1 patient). Fourteen patients had associated autonomic symptoms. The radiosurgical target was the trigeminal nerve (TN) root and the sphenopalatine ganglion (SPG) in 8 patients, only the TN in 8 patients, and only the SPG in 1 patient. The median maximum TN and SPG dose was 80 Gy. Results Favorable pain relief (Barrow Neurological Institute Grades I-IIIb) was achieved and maintained in 10 (59%) of 17 patients at a median follow-up of 34 months. Three patients required additional procedures (repeat GKS in 2 patients, hypothalamic deep brain stimulation in 1 patient). Eight (50%) of 16 patients who had their TN irradiated developed facial sensory dysfunction after GKS. Conclusions Gamma Knife surgery for intractable, medically refractory CH provided lasting pain reduction in approximately 60% of patients, but was associated with a significantly greater chance of facial sensory disturbances than GKS used for trigeminal neuralgia.

Keeping it in the Family: Surviving Political Exile, 1870-1917

A sentence of exile was a regular feature of the Russian revolutionary’s underground career. In order to survive this punishment and continue their struggle against Tsarism, revolutionaries relied on help from their fellow exiles, their party, the Political Red Cross and, often, their families. Historians have rarely acknowledged the role of kin in supporting the revolutionary movement and very few studies have noted the attempts by families to mitigate the worst aspects of a sentence of exile. This article explores the ways in which spouses and siblings, parents and children obtained concessions from the Tsarist authorities regarding their loved ones’ sentences of exile, helped off-set the poverty to which many exiles were reduced, and, above all, combated the sense of loneliness and depression to which those in exile were exposed. This article argues that such familial support had a collective and positive impact on revolutionaries’ experience of exile. More broadly it provides an illuminating case study of the blurred space between public and private which the revolutionary occupied and highlights the way in which the movement depended on help from sympathisers and family members in order to function effectively on a daily basis.

The View from the Edge: The Proyecto Arqueológico Chihuahua (PAC) 1990 to 2010: An Overview

The work of the Proyecto Arqueológico Chihuahua (PAC) has played an integral role in defining the origins and characteristics of the Chihuahua culture area, also known as the Casas Grandes Regional System. PAC has developed a critical suite of radiocarbon dates for the southern zone, undertaken the first substantial investigations of the Viejo period (ca. A.D. 800textendash1200 or 1250) since the early 1960s, and added to knowledge of the southern Medio period (ca. A.D. 1250textendash1450). The project has also elucidated the chronology, settlement patterns, subsistence strategies, and technology for both periods. Results of our research indicate continuity between the Viejo period, characterized by small pithouse settlements, and the pueblo focused Medio period in the southern zone, with some poorly understood external influences from both western Mesoamerica to the south and the American Southwest to the north shaping events within the area.

Mapping the End Times:American Evangelical Geopolitics and Apocalyptic Visions

Over the last quarter-century, evangelicalism has become an important social and political force in modern America. Here, new voices in the field are brought together with leading scholars such as William E. Connolly, Michael Barkun, Simon Dalby, and Paul Boyer to produce a timely examination of the spatial dimensions of the movement, offering useful and compelling insights on the intersection between politics and religion. This comprehensive study discusses evangelicalism in its different forms, from the moderates to the would-be theocrats who, in anticipation of the Rapture, seek to impose their interpretations of the Bible upon American foreign policy. The result is a unique appraisal of the movement and its geopolitical visions, and the wider impact of these on America and the world at large.