Management of a comatose patient with multiple intracranial aneurysms--lessons learned.

The perioperative management of a deeply comatose patient (Glasgow Coma Score, GCS 5) following a spontaneous subarachnoid hemorrhage is presented. Six intracranial aneurysms of the anterior circulation were discovered at operation, contrary to angiographic findings. These were successfully clipped by the author (KD). Postoperatively, the patient's cerebral energy metabolism was monitored by bedside cerebral microdialysis in real time. The ICP (volume)-targeted therapy (Lund concept) was utilised in accordance with findings of intrinsic brain biochemistry. Three-month follow-up showed excellent outcome (Glasgow Outcome Score, GOS 5).