Lenticulostriate artery aneurysms are rare, can be difficult to diagnoze, and when they rupture they are often associated with deep intraparenchymal hemorrhages. In particular, fusiform, dissecting aneurysms of a distal lenticulostriate artery are extremely rare. Typically, they are usually associated with underlying systemic conditions such as systemic lupus erythematosus, moyamoya disease, and substance abuse. Given their usual small size and location, these aneurysms may be difficult to detect with angiography and can be challenging to treat with either endovascular or microsurgical techniques. We provide background information, review the existing treatment experiences reported in the literature, and present a discussion regarding the optimal management using an illustrative clinical vignette. Parent artery obliteration can be a safe and effective treatment in these rare aneurysms.