Artery of Davidoff and Schechter Supply in Dural Arteriovenous Fistulas

Fellows’ Journal Club

The artery of Davidoff and Schechter is a dural branch of the posterior cerebral artery that can supply the meninges close to the falcotentorial junction. It is usually not identified on angiography except when enlarged in the setting of a dural AVF or meningioma. The impact on treatment of the artery of Davidoff and Schechter supply to a fistula is not well-described in the literature. The authors’ retrospective analysis of patients with dural AVFs treated at the Toronto Western Hospital between 2006 and 2018 identified 6 patients with dural AVFs receiving supply from the artery of Davidoff and Schechter (of a total of 173 patients with dural AVFs). All patients were initially treated by transarterial embolization using liquid embolic agents. Three patients required a second endovascular procedure partly due to residual supply from the artery of Davidoff and Schechter.

Abstract

Figure 1 from Bhatia et al
A, Cerebral DSA (patient 3) via a left vertebral artery injection demonstrating arterial supply to a superior sagittal sinus dural AVF by enlarged bilateral arteries of Davidoff and Schechter. Anterior-posterior projection in the arterial phase shows a bilateral enlarged ADS arising from the superior aspect of the P1–2 junctions of the posterior cerebral arteries and converging (black arrows) into an enlarged falcine artery at the falcotentorial junction, with early venous filling of the superior sagittal sinus. Note the presence of cortical venous reflux. B, Lateral projection shows a bilateral enlarged ADS (black arrows) extending posteriorly along the free edges of the tentorium cerebelli and converging adjacent to the falcotentorial junction.

SUMMARY

The artery of Davidoff and Schechter is a dural branch of the posterior cerebral artery that can supply the meninges close to the falcotentorial junction. It is usually not identified on angiography except when enlarged in the setting of a dural AVF or meningioma. The impact on treatment of the artery of Davidoff and Schechter supply to a fistula is not well-described in the literature. Our retrospective analysis of patients with dural AVFs treated at the Toronto Western Hospital between 2006 and 2018 identified 6 patients with dural AVFs receiving supply from artery of Davidoff and Schechter (of a total of 173 patients with dural AVFs). All patients were initially treated by transarterial embolization using liquid embolic agents. Three patients required a second endovascular procedure partly due to residual supply from artery of Davidoff and Schechter, and in all cases, angiographic cure was obtained. The treatment approach, challenges encountered, and potential complications of treating such fistulas are described.

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Artery of Davidoff and Schechter Supply in Dural Arteriovenous Fistulas
Jeffrey Ross
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