One-session bilateral craniotomies for radical clipping of multiple aneurysms have been performed in 14 patients after subarachnoid haemorrhage. Bilateral small or medium sized aneurysms in pre-operatively good-grade Hunt and Hess (HH)I-III) patients (nine cases) were clipped without mortality or morbidity. Four poor-grade patients (HH IV at admission, improving to HH III pre-operatively) were treated, with unfavourable outcome in one patient. Another poorgrade patient (HH IV at surgery) with bilateral large middle cerebral artery aneurysms, a large intracerebral haematoma and a pontine angle meningioma survived with dysphasia and short-memory dysfunction. A slack brain at surgery and a short operation time justify one-session bilateral craniotomies also in the early post-bleeding period.