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Background: While the smoking-related risk of experiencing an aneurysmal subarachnoid hemorrhage (aSAH) is well established, it remains unclear whether smoking has an unexpected "protective effect" in aSAH, or if smokers are more at risk for complications and poor outcomes. Methods: Prospective, observational study investigating the course and outcome of aSAH in patients admitted during the years 2011 and 2012. Smoking status at admittance, demographic, medical, and radiological variables were registered along with management, complications, and outcome at 1 year in terms of mortality, modified Rankin score, and Glasgow outcome score extended. We compared current smokers with nonsmokers on group level and by paired analysis matched by aSAH severity, age, and severity of vasospasm. Results: We included 237 patients, thereof 138 current smokers (58.2%). Seventy-four smoker/nonsmoker pairs were matched. Smokers presented more often in poor clinical grade, had less subarachnoid blood, and were younger than nonsmokers. Ruptured aneurysms were larger, and multiple aneurysms more common in smokers. Severe multi-vessel vasospasm was less frequent in smokers, whereas all other complications occurred at similar rates. Mortality at 30 days was lower in smokers and functional outcome was similar in smokers and nonsmokers. Poor clinical grade, age, cerebral infarction, and vertebrobasilar aneurysms were independent predictors of 1-year mortality and of poor functional outcome. Serious comorbidity was a predictor of 1-year mortality. Smoking did not predict mortality or poor functional outcome. Conclusions: Notwithstanding clinically more severe aSAH, smokers developed less frequently severe vasospasm and had better outcome than expected. The risk for complications after aSAH is not increased in smokers. [ABSTRACT FROM AUTHOR]

Endovascular treatment of ruptured intracranial aneurysms increasingly supersedes surgical repair. This study focuses on the management and results in 109 individuals treated surgically when both treatment modalities were available. The management principles were immediate identification of the origin of haemorrhage, early aneurysm repair, minimal brain retraction during surgery and rigorous prevention of secondary brain damage. Predominantly, aneurysms located on the middle cerebral artery and those of the posterior communicating artery were allocated to surgery. Despite of ultra-swift care, aneurysm rebleeds remained a challenge. Although one-third of the patients presented in a poor clinical grade, outcome was good with 87 (80%) of the individuals being independent, 16 (15%) being dependent and six patients (6%) dying. Results of surgical aneurysm repair are good presupposed the untiring ongoing efforts of an inter-disciplinary team of dedicated physicians and nurses. [ABSTRACT FROM AUTHOR]

In a prospective study of 25 patients with trigeminal neuralgia (TN), we examined the results of microvascular decompression (MVD). Initial pain relief was complete in 22 patients and partial in one. There were two primary failures. After a median observation time of 38 months. 20 of the 22 patients still were completely free of pain, and one patient reported then 50% pain relief. A vascular compression of the trigeminal root was found intra-operatively in 23 patients. No serious complications occurred. Minor but bothersome dyaesthesias were reported by two patients (8%). The results were satisfactory when compared to other MVD studies. [ABSTRACT FROM AUTHOR]

We have evaluated the long-term results of percutaneous retrogasserian glycerol rhizotomy (PRGR) in 60 patients with classical trigeminal neuralgia. Complete initial pain relief was achieved in 93% of the patients. Numbness was initially reported by 3/4 of the patients and at follow-up by 1/3, while long-lasting dysaesthesias were an important side effect in 38% of previously untreated patients. The half-life of the method was 47 months in our material, and this figure compares favourably with other previously reported series. The method carries a significant risk of long-lasting and troublesome sensory disturbances. Another disadvantage of the method, reported in the present long-term study, was the high incidence of recurrent neuralgia. We are unable to identify predictors of recurrent neuralgia after PRGR, although major recurrences were more common in patients with unchanged facial sensation postoperatively. In conclusion, PRGR offers safe and reliable relief of pain in patients with trigeminal neuralgia. In spite of the high incidence of recurrence and of long-lasting dysaesthesias it is, in our opinion, the method of choice in the elderly, and particularly suitable for patients at high risk. [ABSTRACT FROM AUTHOR]