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Xinqiao Hospital, Third Military Medical University, Department of Neurosurgery, Chongqing, China DOI : 10.5137/1019-5149.JTN.9045-13.0 Posterior communicating artery (PCoA) aneurysm-cavernous sinus fistulae are an extremely rare complication of head injury . The treatment of PCoA aneurysm-cavernous sinus fistulae has not been well described. A 27-year-old man was admitted with a retroocular bruit and blurred vision of the left eye seven months after a severe head injury. We report the angiographic appearance of a posterior communicating artery (PCoA) aneurysm with a fistula to the cavernous sinus. This injury had been previously misinterpreted to be a PCoA aneurysm by computerized tomographic angiography (CTA). The patient was successfully treated with coils and Onyx of a fistula between the PCoA aneurysm and cavernous sinus Keywords : Carotid-cavernous sinus fistula, Aneurysm, Endovascular therapy, Posterior communicating artery