A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. Some fistulas are characterized by a direct connection between the cavernous segment of the internal carotid artery (ICA) and the cavernous sinus, whereas others consist of a communication between the cavernous sinus and one or more meningeal branches of the ICA, external carotid artery, or both. These dural fistulas usually have low rates of arterial blood flow and until recently were difficult to diagnose and treat. In this paper, the author discusses the anatomy, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of dural CCFs.