Trigeminal neuralgia is commonly treated with percutaneous balloon compression due to the high success rate, technical simplicity and cost efficiency.1-3 The procedure carries certain risks, most notably dysesthesias and masseter muscle weakness.4 5 However, more severe complications are rare. In this report, the case of a rare complication of percutaneous balloon compression for trigeminal neuralgia is presented, resulting in a carotid cavernous fistula treated via an endovascular approach.