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Introduction/Purpose Tiny unruptured aneurysms (≤3mm) have a favorable natural history in prospective, non-randomized studies, though are sometimes treated. An accurate understanding of their treatment risk is important to aid in decision making.Material and Methods The NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry, a multi-institutional prospective database, was queried for tiny (≤3mm) unruptured aneurysm treatments. Data was excluded from patients with poor pre-treatment mRS (≥2), from aneurysms with previous treatment, from institutions with poor primary outcome reporting (<95%), and from patients missing primary outcome data. The primary endpoint was peri-procedural neurologic decline defined by a discharge mRS of ≥3. Secondary endpoints included rates of intraoperative or postoperative complications, as well as radiographic outcome.Results Of 2481 aneurysm treatments meeting criteria for analysis, 9.4% (233) were tiny (≤3mm). Patients undergoing treatment of tiny aneurysms were younger compared to patients undergoing treatments of aneurysms of all sizes (57±13 vs. 60±13, p=0.001), and 81% (189/233) of treatments were in female patients. The mean (SD) aneurysm size was 2.5 (0.6) mm. Prior (separate) aneurysm repair was present in 31% (71/233) of patients. Smokers comprised 31% (71/233) of patients and 61% (140/231) had hypertension. The most common treatment method was flow diversion (100/233), followed by coiling (89/233), clipping (40/233), and intrasaccular flow device placement (4/233). Poor discharge mRS was seen in 9% (21/233), with 0.9% (2/233) mortality. Of aneurysms with reported radiographic outcome, 47% (110/160) achieved immediate complete obliteration. There was a recorded intraoperative complication rate of 4.7% (11/233) and postoperative complication rate of 8.2% (19/233).Conclusion Among 2,481 elective treatments of unruptured aneurysms, 9.4% were tiny (≤3mm), and 31% of those had a history of repair of a separate aneurysm. The rate of short-term morbidity and mortality associated with their treatment was 9.0% and 0.9% respectively. These results may help further inform tiny aneurysm management.Disclosures C. Fritch: None. S. Shah: None. E. Church: None. S. Simon: None. K. Cockroft: None. D. Wilkinson: None.