Traumatic cerebrovascular injury (TCI) is characterized by traumatic aneurysms, arterial dissection, arteriovenous fistula (AVF) and vasospasm. TCIs are those entities that occur in direct association with a known cerebral trauma. TCI can be treated with either microsurgical techniques or endovascular techniques. The technological advancements in endovascular neurosurgery have made a profound impact on the approach to TCI, making the management of traumatic aneurysms a multi-disciplinary approach. The microsurgical technique is commonly used at the time of initial exploration and decompression of a severe head injury and formal vessel sacrifice. This chapter gives an overview on the natural history, historical approaches, and current microsurgical and endovascular management strategies used for the treatment of TCI. The chapter concludes with two case studies i.e. (i) A 30-year-old soldier with gunshot wound on head and (ii) A 24-year-old army medic suffered a penetrating head injury in a dismounted improvised explosive device (IED) blast.