Aim:Pediatric aneurysms are rare, occurring in under 5% of cases, and their clinical presentation, rupture probability, location, and outcome differ from those in adults. The present study aimed to analyze the demographic characteristics and surgical outcomes of the largest series of patients with pediatric aneurysms reported in Romania, in consideration of the primary factors that lead to good long-term outcomes. Given that all cases involved ruptured aneurysms, we also investigated the ability of microsurgical clipping to prevent massive hemorrhage and aggravation of neurological deficits.Material and Methods:This multicenter retrospective study included 47 pediatric patients (<16 years old) who underwent operation over the 20-year period between January 1999 and January 2019. We analyzed medical records and imaging findings in each patient. Treatment consisted of open microsurgical dissection (clipping) and endovascular embolization (coiling).Results:Mean patient age was 14.3 years, ranging from 5 months to 16 years, with 28 boys (59.5%) and 19 girls (40.4%). In our series, pediatric aneurysms represented 6.1% of all intracranial aneurysms (771 cases). Clinical features were dominated by headache (45 cases, 95.7%), neck stiffness (43 cases, 91.4%) and vomiting (42 cases, 89.3%). The most frequently involved locations were the anterior communicating artery (17 cases, 36.1%), middle cerebral artery (12 cases, 25.5%), and internal carotid artery bifurcation (9 cases, 19.1%). Glasgow Outcome Scale scores at 6 months indicated good recovery in 36 patients (76.5%), moderate disability in nine patients (19.1%), severe disability in one patient (2.1%), and (preoperative) death in one patient (2.1%).Conclusion:Intracranial aneurysms in children are very rare. Early diagnosis based on brain imaging and microsurgical treatment is essential for attaining excellent results. Primary factors such as preoperative status, child profile, aneurysm size, treatment choice, and timing of the operation influence both short and long-term outcomes.