Introduction: Sir Victor Horsley, by treating a cerebral aneurysm in 1885, began a process that has made the therapy of vascular anomalies an accepted part of neurosurgery today. The unit, referred to in the study, sought to learn from its own history.

Methods: We audited the patient population and the success of the management instituted during admission according to Lipschitz Neurological Unit's database within the period 2009-2012.

Results: The clipping of the saccular vascular defects was the default management modality on account of the limited availability of coiling apparatus and of appropriately trained staff. This led to a majority of the patients being clipped, with only a 5.8% mortality but a 6.7% mortality in the coiled group - even before the long-term risk of rupture was factored into the equation. Both of the patients with fusiform aneurysms were HIV reactive, and had a good clinical outcome upon discharge on antiretrovirals - without direct vascular intervention.

Conclusions: The practice of aneurysm management is poised to allow for the treatment of each case according to it’s merits and the conditions at the specific to the institution, for a revision of how we phrase the consent process, and for the individual patient/family’s preference to be the determining factors.

Patient Care: We intend to establish that there is greater benefit in individualizing care, as the stance that endovascular or any other treatment is uniformly superior is inaccurate.

Learning Objectives: • to audit the type and site of aneurysms encountered • to assess the mortality rate of respective interventions (coiling vs clipping) • to assess the rate of good clinical outcomes (WFNS Grade 1 or 2) • to evaluate the relation between outcomes, treatment modality and the site of aneurysms • to establish the type of aneurysms has a bearing on short-term outcomes in the study population

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