Arteriovenous fistulas in the cavernous sinus region are usually classified as spontaneous or traumatic, while the former is generally considered to occur after a skull base fracture when a bone fragment punctures the adjacent internal carotid artery, allowing blood to enter the cavernous sinus resulting in a so-called traumatic carotid-cavernous sinus fistula (CCF); its management has been routinized. The latter is due to thrombophlebitis of the middle cranial sulcus and the surrounding skull base, which induces abnormal shunting of the vessels out of the prior arteriovenous traffic, called spontaneous cavernous arteriovenous fistula (AVF), whose fistulae are small in diameter and large in number, and even involve the external carotid artery system to form a large range of lesions, so it can cause greater difficulties in treatment. Due to the complexity of the anatomical structure, endovascular embolization is currently considered as the first treatment option. To control the development of local venous thrombosis, the literature mostly reports the appropriate application of anticoagulants for prevention before and after treatment. When AVF is formed in the cavernous sinus area, when judging the severity of the lesion and the need for treatment, it is important to pay attention not only to the size and number of fistulae and the source of blood supply, but also to analyze the direction of blood flow back into the fistula. intercavernous sinus; upward through the meningeal and lateral fissure veins; and downward through the pterygopalatine fossa venous plexus. Of these, drainage to the lateral fissure usually enters the cortical veins, and the elevated pressure in the cortical vessels induces hemorrhage in the brain parenchyma and subarachnoid space. When there is increased reflux in the superior and inferior ophthalmic veins, there is ocular congestion and increased intraocular pressure, which can cause visual impairment when it increases in intensity and duration. In cases where the direction of drainage is concentrated in the inferior and superior petrosal sinuses, a pulsatile murmur consistent with the beating of the heart may occur due to the higher pressure difference between the cavernous sinus and the internal jugular vein. In terms of endovascular treatment, transarterial embolization, which is simple to perform, is the first option, but for more complex AVFs such as multiple fistulas, embolization through the superior ophthalmic vein or superior and inferior petrosal sinuses is more likely to occlude all fistulas; due to the complex nature of the lesion, combined arteriovenous embolization may be the ideal approach in more cases. In the choice of embolization materials, liquid embolization agents (NBCA and Onyx) should be more effective than spiral coils, and the application of a mixture of both materials for embolization can prevent excessive dispersion of liquid embolization agents while adequately occluding the different fistula openings; this is the most common choice in the treatment of cavernous sinus AVF embolization in our group. Similar to the risk of all meningeal AVF in humans, the main risk of AVF in the cavernous sinus region is the induction of intracranial hemorrhage due to fistula blood draining into the cortical veins; secondly, the loss of vision due to highly congested supraocular veins. These two points should be the main indications for embolization in the management of AVF of the cavernous sinus. In view of the four principles of effectiveness, feasibility, safety and economy of endovascular treatment, when the possible ischemic injury to the nerves at the base of the skull and the chance of retrograde occurrence of intracranial vascular misembolization in embolization treatment increase, if the lesion characteristics of intracranial cortical drainage and visual impairment are not present, it is not necessary to force embolization but to switch to conservative observation and symptomatic management, or to change from complete embolization in design to partial If the lesion characteristics change during follow-up to facilitate safe embolization, secondary treatment will be performed; in order to maximize the possibility of both eliminating high-risk factors for spontaneous cavernous sinus AVF and ensuring the quality of patient survival.