J Cerebrovasc Endovasc Neurosurg.  2022 Sep;24(3):281-290. 10.7461/jcen.2022.E2021.09.004.

Anatomical safety and precaution of transarterial embolization of a falcotentorial dural arteriovenous fistula fed by the artery of Davidoff and Schechter: Case report and review of the literature

• Woo SB
• Kim JH
• Kwon MY
• Lee CY

• KMID: 2533681
• DOI: http://doi.org/10.7461/jcen.2022.E2021.09.004

Abstract

The artery of Davidoff and Schechter (ADS), a pure meningeal branch of the posterior cerebral artery (PCA), is often reported as a feeder of the tentorial dural arteriovenous fistula (TDAVF). However, there are few reported cases of embolization via this artery. We present an interesting case of a patient with incidentally found TDAVF fed by the ADS and with fetal type posterior communicating artery, in which the feeder was confused with the PCA due to the similar pathways around the brain stem. It was successfully treated with transarterial embolization through the ADS. We reviewed related published articles to determine the safety of embolization via the ADS.

Keyword

Endovascular procedures; Arteriovenous fistula; Meningeal arteries; Fetal type posterior communicating artery

Figure

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  Fig. 1. (A, B) Anteroposterior and oblique view of Lt VA angiography showing TDAVF fed by the ADS (black arrow), mimicking Lt PCA, draining to vein of Galen (white arrow) Lt PCA flow is not visualized due to Fetal type PCoA. (C) 3-dimentional reconstruction of oblique view of left VA angiography. ADS (left white arrow) and fistulous point, great cerebral vein of Galen (right white arrow). (D) Lateral view of left ECA angiography showing additional feeder (black arrow) from occipital artery. VA, vertebral artery; TDAVF, tentorial dural arteriovenous fistula; ADS, artery of Davidoff and Schechter; PCA, posterior cerebral artery; PCoA, posterior communicating artery; ECA, external carotid artery

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  Fig. 2. (A, B) Intraoperative angiography, access to distal portion of the feeder, ADS, was achieved with Detachable-tip microcatheter. (C) Postoperative VA angiography showing occlusion of the fistula by onyx (black arrow) and revealed entire left PCA (black arrow head) which was not visualized preoperatively due to the high flow of the ADS and fetal type PCoA (double arrow). Small residual proximal portion of ADS (white arrow) is also seen, arising at P1-PCoA junction. (D) Postoperative ECA angiography, demonstrating occlusion of AV shunt. (E) 1-year follow up MRA (rt picture) showed no recurrence of the AV shunt (white arrow). ADS, artery of Davidoff and Schechter; VA, vertebral artery; PCA, posterior cerebral artery; PCoA, posterior communicating artery; ECA, external carotid artery; AV, arteriovenous; MRA, magnetic resonance angiography

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  Fig. 3. (A) 3-Dimentional reconstruction of preoperative MRA. Similar pathway of the feeder ADS arising from P1-PCoA junction (left arrow) and left PCA (right arrow) getting flow from fetal type of PCoA (arrow head) is demonstrated. (B) Lateral view of 3-Dimentional reconstruction, demonstrating ADS (arrow head), arising from junction of P1 (double arrow) and PCoA (arrow). MRA, magnetic resonance angiography; ADS, artery of Davidoff and Schechter; PCoA, posterior communicating artery; PCA, posterior cerebral artery

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