Traumatic Carotid Cavernous Fistula (tCCF) is seen in a variety of craniocerebral trauma, most commonly caused by skull base fractures. The incidence of traumatic internal carotid cavernous sinus fistula is about 2.5%. According to statistics, more than 75% of internal carotid cavernous sinus fistulas are caused by trauma. Because the cavernous sinus segment of the internal carotid artery is firmly anchored by the dura mater at its entrance and exit, the artery or its branches can be torn when the fracture line crosses the middle cranial fossa or penetrates to the saddle. This can sometimes be caused by direct injury from fracture fragments, penetrating injuries, or flying projectiles. The damaged artery may rupture immediately or delayed, so the time between the injury and the onset of symptoms of arteriovenous fistula varies from acute to late onset of several days to several weeks, often followed by an asymptomatic interval. Clinical manifestations 1. Local symptoms and signs: they are caused by direct perfusion of internal carotid artery blood into the cavernous sinus. (1)Pulsatile proptosis: within 24h after injury, there is a congestion and edema of the conjunctiva of the affected eye, an exophthalmic proptosis with a pulsation consistent with the heart rhythm, and an angry frontotemporal scalp vein. (2) Tremor and murmur: The patient can hear the continuous murmur by himself, which is enhanced with the contraction of the heart, and there is tremor in the eye on palpation, and the blowing murmur and catarrhal tremor can be heard on auscultation in the eye, frontal orbital region and temporal region, both of which are consistent with the pulse, and the murmur is significant enough to make the patient insomniac. (3) Visual impairment: due to elevated intraocular venous pressure, retinal edema and hemorrhage, optic disc edema, or primary optic nerve atrophy due to compression of the optic nerve by the enlarged cavernous sinus, resulting in visual impairment. (4) cavernous sinus and supraorbital fissure syndrome: about 70% of patients have limited eye movements, especially the involvement of the spreading nerve and the motoneurotic nerve, which can cause diplopia, and in severe cases can lead to conjunctivitis, corneal ulceration, glaucoma and optic nerve atrophy with pressure on the eye, and even blindness. Occasionally, patients have symptoms of the ophthalmic branch of the trigeminal nerve, such as frontotemporal and orbital pain or forehead skin sensory disturbance and diminished corneal reflexes. In addition, some patients may have bilateral ocular symptoms and signs due to the large intercavernous sinus, which is prone to bilateral traffic. 2. Whole brain symptoms: This is caused by cerebral ischemia. When the internal carotid artery cavernous sinus fistula, a short-circuit blood circulation is formed between the artery and the cavernous sinus, which affects the perfusion of the middle cerebral artery and the anterior cerebral artery on the distal side of the fistula, and the corresponding distribution area suffers from cerebral ischemia, and the long-term cerebral ischemia causes functional damage to the brain. Sometimes the intracranial pressure may be increased. CT (CTA), MRI (MRA) and ultrasound can be used as auxiliary examinations, but the gold standard for diagnosis is DSA angiography, through which we can understand the location of the lesion, the blood supply artery, the location and size of the building, whether the anterior and posterior cavernous sinuses are visualized through the anterior and posterior cavernous sinuses, theft of blood and venous return, and through the contralateral internal carotid artery and vertebral artery angiography to understand the intracranial collateral circulation. Treatment of traumatic internal carotid cavernous sinus fistulas has a low chance of healing on its own, only 5-10%, and occasionally it can be successfully treated by compression of the affected carotid artery (Mata’s Test) to reduce the blood flow to the fistula and promote healing. 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. The most reliable treatment for traumatic carotid cavernous sinus fistula is endovascular intervention, with embolization of the detachable balloon fistula being the treatment of choice.