Carotid cavernous fistula (CCF) is an abnormal communication between the carotid artery or its branches and the cavernous sinus. Barrow staging is one of the most widely used imaging staging methods in clinical practice and is a guide to the choice of treatment. type A direct fistula, in which the internal carotid artery forms a fistula directly with the cavernous sinus, type BCD, both indirect fistulas, type B, in which a branch of the external carotid artery forms a fistula with the cavernous sinus, and type C, in which a branch of the external carotid artery forms a fistula with the cavernous sinus. A direct fistula, where the internal carotid artery forms a fistula directly with the cavernous sinus, BCD, both indirect, B, where the meningeal branch of the internal carotid artery forms a fistula with the cavernous sinus, C, where the branch of the external carotid artery forms a fistula with the cavernous sinus, and D, where there is a fistula between the meningeal branch of the internal and external carotid arteries and the cavernous sinus. Traumatic carotid cavernous sinus fistula (TCCF) is a relatively common complication of craniocerebral trauma and the preferred treatment is endovascular intervention, although there have been tremendous advances in interventional techniques and materials, latex removable balloons are still the embolic material of choice for the treatment of this condition. The vast majority of fistulas are high-flow direct fistulas, which account for approximately 75% of CCF. All patients in this group had different degrees of craniocerebral trauma before surgery, and post-injury CT scans of the head showed The introduction of balloon embolization of CCF by Scholars such as Serbinenko and Debrun has revolutionized the treatment of this once incurable disease and established the place of balloon endovascular techniques in the treatment of TCCF. Currently, despite the development of interventional techniques and interventional materials, the detachable balloon remains the preferred and ideal material for the endovascular treatment of TCCF. The detachable balloon has the advantages of being economical, simple to perform, and can be repeatedly filled or repositioned to occlude the majority of fistulas and keep the internal carotid artery patent in a group of 482 cases published by WuZ et al. The success rate of treatment in this group was 100%, and the retention rate of the affected internal carotid artery was 95.7%. Other endovascular treatment embolization materials include spring coils, Onyx glue, and overlapping stents. The overlapping stent is a new option for TCCF treatment, especially in the treatment of complex CCF. The overlapping stent can seal the fistula and keep the internal carotid artery open, avoiding nerve compression in the cavernous sinus and not interfering with ocular venous return. However, the overmolded stent is less compliant and has difficulty passing through more tortuous vessels, and may also block important role of collateral vessels, requiring long-term postoperative anti-poly drugs, which may result in in-stent stenosis or internal carotid artery occlusion. Removable latex balloon embolization TCCF is a relatively safe interventional procedure operation. The aim of the procedure is to close the fistula, eliminate clinical symptoms, protect vision, and promote neurological recovery. A careful evaluation of the cerebral angiogram is required before the procedure to define the location, morphology and drainage pattern of the fistula and to select the appropriate size balloon. The balloon is slowly and partially filled with blood flow through the fistula, and the balloon can be delivered smoothly into the fistula, and then the left hand controls the balloon catheter and adjusts the position of the balloon while filling the balloon. The balloon will be released safely if the balloon catheter is gently and continuously pulled and a certain tension is maintained. If the balloon moves when it is released, stop the release immediately, reposition the balloon or continue to fill the balloon and wait until the embolization is satisfied that the balloon position is fixed before releasing it. In some cases where the balloon cannot enter the fistula or where simple fistula embolization is not possible, it is often necessary to seal the fistula by occluding the internal carotid artery on the affected side. A BOT test is required to assess collateral compensation before occlusion of the internal carotid artery. Some reports suggest that even in patients with clinically negative BOT test results 5-22% may still have delayed cerebral ischemia, so a BOT test under blood pressure control is necessary to reduce the proportion of patients with false negatives. In our clinical work, we recommend routine Matas test before treatment to promote vascular compensation on the affected side and increase the safety of intraoperative occlusion of the internal carotid artery. 2 patients in our group underwent intraoperative balloon occlusion of the internal carotid artery without any neurological deficits after surgery. Complications of endovascular treatment of TCCF with detachable latex balloons include: (1) Premature balloon release or escape: causing occlusion of the internal carotid artery or distal intracranial vessels. Avoidance is achieved by strict adherence to assembly requirements when assembling the balloon and balloon microcatheter, gentle handling of the procedure, filling after the balloon is in place, and avoiding repeated pushing and pulling of the microtube as much as possible. (2) Cavernous sinus syndrome: balloon in cavernous sinus can cause occupancy effect, compress nerves in cavernous sinus and cause neurological dysfunction, which can mostly be relieved within 3 months. (3) Cerebral ischemia or overperfusion: Matas test is routinely performed 2 weeks before surgery to improve the tolerance of brain tissue to ischemia, especially in cases where the internal carotid artery needs to be occluded, BOT test must be performed for evaluation, and postoperative treatment such as volume expansion and pressure boosting can mostly avoid ischemic events. Over-perfusion or “normal perfusion pressure breakthrough” occurs in about 1.2% of CCF cases, and is due to a series of clinical symptoms caused by the sudden occlusion of the fistula, which can be life-threatening in severe cases. Therefore, it is necessary to closely monitor the patient’s blood pressure and clinical symptoms after balloon occlusion of the fistula. (4) Recurrence or balloon displacement: Most commonly seen 1 week postoperatively, recurrence of CCF may occur due to balloon rupture caused by the presence of bone spurs during TCCF treatment. The latex balloon can remain filled in the cavernous sinus for 3-5 weeks, and it takes about 1 week for the endothelium to form after fistula closure, so the postoperative balloon displacement is mostly related to the lack of postoperative head braking. It is recommended that patients undergoing balloon embolization for CCF should be bedridden for 1 week after surgery. It can be seen that for the direct type of TCCF, endovascular embolization with removable latex balloons is a safe, highly successful, and inexpensive treatment option. The low recurrence rate at long-term follow-up and the absence of treatment-related neurological deficits in patients should be the treatment of choice for this type of disease.