Excision of a ruptured aneurysm located at a lenticulostriate feeding artery associated with an arteriovenous malformation was performed using image guided neuronavigation in an 8-year-old child. The management of this lesion, which is rare in childhood, demonstrates the potential of combining frameless stereotaxy for precise target approach with conventional open microneurosurgery to minimize morbidity. Because of the unavoidable shifting of the brain that occurs during surgery, a catheter pointing towards the dome of the aneurysm was placed using image guidance prior to insertion of spatulae.