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Direct anterior cerebral artery-cavernous sinus fistula is an extremely rare complication of head trauma. We describe a male patient (age 49 years) with a history of head trauma 15 years ago who was hospitalised for a bulging red eye and tinnitus. Digital subtraction angiography showed a direct anterior cerebral artery (fork junction A1 - prior passage)-cavernous sinus fistula. The patient was treated with arterial endovascular intervention, complete sealing of the fistula orifice using coils. He was discharged 5 days later with no symptoms of a bulging red eye, ringing in the ears, or nerve paralysis. Re-examination after 3 months of stable clinical features did not show recurrent fistula. In conclusion, anterior cerebral artery-cavernous sinus fistula is an extremely rare lesion, and arterial endovascular intervention using coils is a safe and effective method for treatment of such lesion., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)