This study investigated the use of interventional bronchoscopic techniques in the management of patients with symptomatic tracheobronchial stenosis from tuberculosis.The current authors evaluated their experience with interventional bronchoscopic techniques in 21 consecutive patients at the Singapore General Hospital, Singapore, from November 1994 to March 2001. All patients underwent rigid bronchocopy using the Dumon rigid ventilating bronchosope under general anaesthesia. A combination of techniques was used (mechanical or balloon dilatation, Nd-YAG laser and stenting using the Dumon stent).The mean±sdincrease in luminal diameter of the tracheal lesions was from 4.5±2.5 mm pre-procedure to 11.9±1.7 mm post-procedure, whereas that for the mainstem bronchi stenosis was from 2.6±1.0 mm to 8.3±2.4 mm. All patients had immediate relief of symptoms post-intervention. Two patients who presented with acute respiratory failure could be weaned off mechanical ventilation immediately post-procedure. At the end of the study period, 52% (11 out of 21) remained asymptomatic.Bronchoscopic intervention provided immediate symptomatic relief in all of the studied patients. However, repeated sessions may be required to maintain this improvement. It is concluded that interventional bronchoscopic techniques are useful in the management of patients with tracheobronchial stenosis from tuberculosis.

O r i g i n a l A r tic le 332 I NTRO D U C TIO NSubarachnoid haemorrhage (SAH) secondary to intracranial aneurysm rupture remains one of the most serious neurosurgical emergencies today. Intracranial aneurysms are acquired cerebrovascular anomalies that develop throughout a patient's lifetime.(1) They are arterial lesions defined by thinned and dilated regions of the cerebrovascular wall that exhibit loss of the internal elastic lamina, thinning of the tunica media, and subsequent remodelling and degradation of extracellular matrix proteins throughout the vessel wall. Most aneurysms occur at bifurcation sites along the Circle of Willis, as these areas are prone to haemodynamic patterns that potentiate aneurysm development.( 2) The key to minimising the risk of rebleeding following aneurysmal rupture is to isolate the aneurysm from its cerebral circulation. In this regard, surgical clipping and endovascular coiling are both effective, although there has been much debate on the merits of each intervention. there has been much criticism of the trial, as was eloquently highlighted by the BRAT study. For example, it has been cited that in the ISAT, almost 80% of aneurysms were excluded, the proficiencies between the different interventionists and neurosurgeons were varied, and the types of recruiting centres as well as type and location of aneurysms between groups had wide differences. (3,4) Furthermore, the subsequent five-year follow-up data of the ISAT suggest that the benefit in outcome seen at six months had vanished over the ensuing years.However, the current results of the ongoing BRAT study haveshown that a policy of intent to treat by endovascular coiling results in a reduction of poor clinical outcome at one-year of follow-up.Our study was a retrospective audit of our institution's experience in the management of ruptured intracranial aneurysms. We assessed the overall outcomes of patients admitted for SAH secondary to aneurysmal bleeding, and

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