Discover the case of a 41 year-old man presented to ED with occipital headache, associated with neck pain and vomiting. CT and CTA revealed a small 4th intraventricular hemorrhage, with abnormal dilated tortuous vascular structures around Foramen Magnum, draining into the left tentorial veins with multiple flow aneurysms. Different treatment options were considered: engaging one of the arterial twigs, venous access treatment, sacrificing the right vertebral artery proximal to PICA, or surgery... Which one did they choose, and why? And what were the outcomes? Watch this video from Mohammad Elhissi during LINNC Americas 2022 to find out!