Background <p>Treatment for arteriovenous fistulas located at the craniocervical junction involving the pial feeder aneurysm is challenging. When a direct aneurysm manipulation is not feasible, shunt interception to achieve flow reduction is a considerable option. However, a potential risk for remnant or recurrence of aneurysm may exist due to residual minor shunt flow from small vessels that are undetectable using conventional digital subtraction angiography.</p> Case presentation <p>A 44-year-old Asian man presented with sudden-onset left occipital headache, right thermoanesthesia, and left hemiparesis due to hematomyelia of the cervical spine. Digital subtraction angiography revealed epidural arteriovenous fistula with aneurysmal formation on the anterior spinal artery. As a direct approach to the aneurysm was difficult, the anterior spinal artery was intercepted from the fistula. During surgery, an endoscope-integrated indocyanine green videoangiography allows a clear visualization of abnormal small vessels that were not fully evaluated using digital subtraction angiography. Although the aneurysm blood flow was remnant, shunt interception was confirmed through endoscopic findings of disappearance of blood flow to these small vessels, leading to subsequent aneurysm obliteration.</p> Conclusion <p>In the treatment of dural arteriovenous fistulas with anterior spinal artery aneurysm, a more precise assessment of small vessels and their occlusion is possible through the use of an endoscope-integrated indocyanine green videoangiography.</p>