An intracranial non-galenic pial arteriovenous fistula (NGPAVF) is a direct connection between the intracranial artery and vein without a nidus. NGPAVFs are clinically rare, and the current understanding of NGPAVFs is limited. This study searched PubMed for the currently available literature, and a review of the relevant publications revealed that NGPAVFs require aggressive treatment, spontaneous occlusion is uncommon, and the prognosis following conservative treatment is poor. NGPAVFs can be divided into congenital and traumatic (including iatrogenic) types. Clinically, NGPAVFs are characterized by congestive heart failure, epilepsy, hemorrhage, mass effects, and nerve function deficits. For the imaging examination of NGPAVFs, digital subtraction angiography (DSA) is still the gold standard for diagnosis, although magnetic resonance DSA (MRDSA) and 4D computed tomography angiography (CTA) can also provide hemodynamic data in a non-invasive manner. Current treatments for NGPAVFs include surgical resection and endovascular embolization, both of which can yield clinical improvements. However, potential postoperative complications should be addressed, such as fatal bleeding due to rupture and deep vein thrombosis. Some studies recommend postoperative anticoagulation to reduce postoperative thrombotic complications.