Traumatic carotid-cavernous fistulas (tCCFs) after penetrating brain injury (PBI) have been uncommonly described in the literature with little guidance on optimal treatment. In this case series. we present two patients with PBI secondary to gunshot wounds to the head who acutely developed tCCFs. and we review the lead-up to diagnosis in addition to the treatment of this condition. https://www.chiggate.com/