The clinician must be aware of the potential for vascular injury that can result from gunshot wounds to the skull base and oropharynx. These lesions can be life-threatening or can result in irreversible neurologic defects. The goal is early diagnosis and efficient appropriate treatment. Endovascular therapy has been proven to be of great benefit for the treatment of traumatic aneurysms and carotid-cavernous fistulae. Utilizing either a reconstructive or a deconstructive approach, the traumatic lesions can be treated without the morbidity inherent to surgery of the skull base or cavernous sinus. This article discusses the authors' experience with endovascular treatment, explaining in detail the reconstructive and deconstructive approaches and providing clinical examples of the treatment of pseudoaneurysms and carotid-cavernous fistulae.