There is limited evidence to suggest that anterior approaches for the resection of ventral intramedullary lesions of the cervical spinal cord may result in superior neurological outcomes compared with those following more traditional posterior approaches. To the authors’ knowledge, no report of an anterior approach to resect a ventral intramedullary capillary hemangioma exists in the literature. In the following paper, the case of a 75-year-old male who presented with progressive neck and left shoulder pain, weakness of the left hand, myelopathy, and gait imbalance is reported. Postcontrast T1-weighted MRI demonstrated a homogeneously enhancing intramedullary lesion with associated severe impingement of the cervical spinal cord at C-4. Following a C-4 corpectomy, intradural exposure revealed a vascular lesion that circumferentially enveloped the anterior spinal artery. Gross-total resection of the lesion was performed, followed by reconstruction of the corpectomy defect, without neurological deterioration. Pathology was consistent with capillary hemangioma. In this instance, the anterior approach helped to avoid unnecessary neural manipulation and allowed for early identification of normal proximal and distal segments of the anterior spinal artery, which facilitated safe dissection and gross-total removal.