Traumatic internal carotid cavernous sinus fistulas have little chance of healing spontaneously, only 5-10%, and may occasionally heal successfully by reducing the blood flow to the fistula through compression of the affected carotid artery (Mata’s Test). In the vast majority of cases, surgery is necessary to restore the normal physiology of the cavernous sinus, to relieve pressure on the venous system, to restore the protruding eye, to save vision, to eliminate murmurs, and to prevent cerebral ischemia. There are many surgical methods, but the method of ligating the affected internal carotid artery in the neck alone has been largely abandoned. There are two types of treatment methods in common use, namely surgical embolization and endovascular embolization. These are craniotomy to isolate the fistula, copper wire embolization, and direct fistula repair. The Mata’s training and cross-filling examination of the cerebral vessels must be done before the operation to ensure that the collateral circulation has been established; otherwise, once the internal carotid artery is blocked, there is a risk of paralysis and aphasia. 1. Isolated embolization: The proximal and distal ends of the internal carotid artery fistula are ligated in the middle of the neck and in the skull, respectively, so that the fistula hole is isolated and closed. However, this procedure completely blocks the blood supply of the internal carotid artery, so it should only be considered if the collateral circulation has been established and the vision of the healthy side of the eye is good, because the blood supply of the affected ophthalmic artery is often not preserved and therefore there is a risk of blindness. In addition, the other branches of the cavernous sinus segment of the internal carotid artery have the possibility of recurrence when there is a bypass blood supply, so it is necessary to inject a muscle plug through the neck to occlude the fistula to improve the efficacy. Procedure: Under general anesthesia, an incision is made through the affected neck to reveal the internal carotid artery and prepare for dissection. Then, the frontotemporal bone flap is opened with the pterygoid point as the center, the dura mater is cut and the cerebrospinal fluid of the lateral fissure pool is discharged, the optic nerve is revealed inward along the pterygoid crest, and part of the orbital roof and the upper wall of the optic canal are removed to reveal the beginning of the ophthalmic artery. It is advisable to clip the ophthalmic artery together when blocking the internal carotid artery to reduce the chance of backflow of blood supply. If the intracranial operation is performed, the internal carotid artery in the neck can be temporarily disconnected due to venous anger affecting the exposure, which is conducive to the smooth operation. After the cranial operation is completed, the cranial cavity is closed and the layers of the scalp are sutured as usual. Then reenter the cervical field, and with the common, internal and external carotid arteries temporarily disconnected, the internal carotid artery is incised and a 4-mm inner diameter plastic tube is inserted and tied with a thick silk thread to avoid blood leakage. A muscle plug was then injected into the cavernous sinus segment of the internal carotid artery to occlude the fistula hole. After surgery, the plastic tube is removed, the internal carotid and common carotid arteries are ligated, and the neck incision is closed as usual. 2, cavernous sinus fistula copper wire embolization: that is, the use of bare copper wire with positive electricity, inserted into the cavernous sinus leak area through craniotomy, so that the negatively charged blood cells and fibrin attached embolization. The advantage of this method is that it does not affect the patency of the internal carotid artery and there is no risk of distal ischemia, so it is suitable for patients with bilateral cavernous sinus fistula. Procedure: Under general anesthesia, the lateral wall of the cavernous sinus in the middle cranial fossa is exposed by craniotomy through the frontotemporal flap, and the temporal tip can be partially excised if necessary to facilitate the operation. A sterilized fine copper wire (0.15-0.2 mm diameter) 4-5 cm long is prepared in advance and pierced into the sinus wall bulge with a copper wire guide sleeve needle. Then insert the copper wire continuously for about 1 cm until there is resistance, cut it off, and replace it with another site with tremor or bulge and insert it again until the cavernous sinus is flat and firm and the tremor disappears.