Abstract: Objective To evaluate the choice of approaches,surgical techniques and clinical outcome of endovascular embolization for treating traumatic carotid cavernous fistula (TCCF).Methods A retrospective analysis of 119 patients with TCCF was conducted,in whom totally 128 embolizations were performed. In these procedures,the femoral artery approach was adopted in 112 cases,femoral vein approach in 5 cases,and superior ophthalmic vein approach in 2 cases. For the embolization materials,balloons were used in 101 cases,microcoils in 13 cases,both materials in 2 cases,and lyophilized dura mater in 3 cases. After the embolization procedures,110 patients were followed-up for 3 months to 10 years,and 29 patients reexamined with angiography. Results Successful embolization for TCCF in a single procedure was achieved in 111 cases,and failure occurred due to balloon leakage in 8 cases,all embolized successfully in a second attempt. The total success rate was 100% in these cases,with a rate of internal carotid artery patency of 90.8% (108/119). No perioperative mortality or complication occurred,nor was TCCF recurrence seen during the follow-up.Conclusions In general,TCCF can be successfully treated by balloon embolization via the femoral artery,while microcoil embolization has better performance for small fistula. Embolization can be done through venous approach when the internal carotid artery is ligated or occluded,and no procedure should be performed at the convenient expense of the internal carotid artery. Right choices of the approaches and embolization materials are key to the success of the procedure.