A carotid-cavernous fistula (CCF) is the result of an abnormal vascular connection between the internal carotid artery (ICA) or external carotid artery (ECA) and the venous channels of the cavernous sinus. Pial arteriovenous fistulae (AVF) are rare vascular lesions comprising single or multiple arterial feeders draining directly into the venous channel. Like arteriovenous malformations, interventional radiology can treat arteriovenous fistulas with endovascular embolization and stereotactic radiosurgery.