Background There are limited outcome data to guide the choice of treatment in pediatric patients with cerebral aneurysms. Objective To describe our institutional experience treating pediatric patients with cerebral aneurysms and to conduct a meta-Analysis of available studies to provide the best current evidence on treatment related outcomes. Methods We identified pediatric patients with cerebral aneurysms evaluated or treated at our institution using a comprehensive case log. We also identified studies to include in a meta-Analysis through a systematic search of Pubmed, SCOPUS, EMBASE, and the Cochrane Database of Systematic Reviews. As part of both the local analysis and meta-Analysis, we recorded patient characteristics, aneurysm characteristics, management, and outcomes. Statistical analysis was performed using Fisher's exact test and the two tailed Student's t test, as appropriate. Results 42 pediatric patients with 57 aneurysms were evaluated at our institution, and treatment specific outcome data were available in 560 patients as part of our meta-Analysis. Endovascular and surgical treatments yielded comparable rates of favorable outcome in all children (88.3% vs 82.7%, respectively, P=0.097), in children with ruptured aneurysms (75% vs 83%, respectively, P=0.357), and in children with unruptured aneurysms (96% vs 97%, respectively, P=1.000). Conclusion Endovascular and surgical treatment yield comparable long term clinical outcomes in pediatric patients with cerebral aneurysms.