Objective To investigate the safety and efficacy of Onyx combined with coil embolization in the treatment of traumatic carotid cavernous fistula (TCCF), and to summarize the treatment experience. Methods The data of 50 patients with Barrow type A TCCF who received Onyx combined with coil embolization in our center from Jan. 2009 to Jun. 2020 were retrospectively analyzed. The imaging and clinical results were evaluated after treatment. The prognosis was evaluated by clinical and imaging follow-up. Results There were 27 males (54%) and 23 females (46%) in 50 TCCF patients, with an average age of (45±15) years (range, 17-78 years). The patients had varying degrees of symptoms (exophthalmos, bulbar conjunctival congestion, limited eye movement, intracranial murmurs, etc.). The fistulas disappeared in 46 cases (92%) immediately after the procedure, and little residuals were found in 4 cases (8%). The related symptoms were relieved or disappeared to different extents. Perioperative complications occurred in 2 patients (4%). The follow-up duration was 4 (2-9) months. During the follow-up period, fistulas completely disappeared in all patients and the remaining symptoms also disappeared, except for 3 cases of visual impairment and 1 case of ophthalmoplegia. Conclusion Onyx combined with coil embolization is safe and effective in the treatment of TCCF, and it is one of the ideal ways to treat TCCF.