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The authors report a case of a 46-year-old woman with bilateral spontaneous carotid-cavernous fistulas(CCFs). The patient was treated by endovascular management via multiple trans-arterial and trans-venous routes. Left side CCF was embolized completely via surgically exposed superior ophthalmic vein route. Right side lesion was tried by multi-modality endovascular trajectories and achieved partial thrombosis by trans-arterial approach. The follow-up angiogram two months after the last embolization showed a complete bilateral elimination of fistulas. Embolization of bilateral complex CCFs can be achieved by multiple trans-arterial and trans-venous routes, including direct surgical exposure of superior ophthalmic vein.