Traumatic arteriovenous fistula (aVF) is one of the most misdiagnosed complications of vascular injuries. We report the case of a 63-year-old man who suffered a knife wound to the left neck twenty-five years ago. after surgery, the recovery was uneventful and the patient was discharged without any problems. Several weeks after surgery, the patient noticed a cervical thrill, tinnitus, bruit and headache. Since 2014, the patient suffered from right-sided trigeminal neuralgia (TN), which poorly responded to medical treatment. on admission, the neurological examination revealed a left-sided hemifacial spasm and hyperesthesia in the right V1 and V2 dermatomes. Magnetic resonance imaging showed marked congestion of the surface hemispheric veins and right cerebellopontine region with venous compression of the right trigeminal nerve. Digital subtraction angiography confirmed an aVF of the left neck involving the left thyreocervicial trunk, the V3 segment of left vertebral artery and the left internal jugular vein (IJV). The aVF exhibited retrograde flow into the left sigmoid sinus, left transverse sinus and increased intracranial venous pressure. The fistula was succesfully embolized via femoral and radial acces using liquid embolic agents. after the procedure, tinnitus, bruit and headache disappeared. Whereas the patient continued to suffer from TN, we decided to perform percutaneous trigeminal ganglion compression. according to this case, we recommend systematic investigation of penetrating neck injuries for aVF. early treatment of aVF is necessary in order to avoid associated complications.