2025 Proffered Presentations
S379: TREATMENT AND PRESENTATION OF DURAL ARTERIOVENOUS FISTULAS FED BY THE ARTERY OF DAVIDOFF AND SCHECHTER: A SCOPING REVIEW OF THE LITERATURE
Estefana Bcharah; Maria José Pachón-Londoño, MD; Vita Olson; Maged T Ghoche, MD; Abhijith R Bathini, MD; Charbel Moussalem, MD; Devi P Patra, MD; Bernard R Bendok, MD, MSCI; Mayo Clinic
Introduction: The artery of Davidoff and Schechter (ADS) is the only dural branch of the posterior cerebral artery (PCA) that supplies the falcotentorial junction. It is not commonly depicted on angiography due to its small size; thus, its visibility is indicative of a pathology, such as a dural arteriovenous fistula, arteriovenous malformation, meningioma, or aneurysm. It is notably distinct from the Artery of Wollschlaeger and Wollschlaeger (AWW), a dural branch of the superior cerebellar artery. This scoping review aims to synthesize the current body of literature and understanding of this unique artery in the context of the most commonly associated pathology, dural arteriovenous fistulas (DAVF).
Methods: A scoping review in accordance with PRISMA-ScR guidelines was conducted on DAVFs fed by the ADS in July 2024. A search through several databases was performed through a combination of terms and their equivalents. To meet the inclusion criteria of our search, articles must be primary case reports or series that discuss the ADS, or relevant dural or meningeal branches of the PCA, in the context of a DAVF.
Any review articles, anatomical studies, articles that discussed a DAVF fed by arteries other than the ADS, or did not describe the ADS as a branch from the PCA, were excluded. Subsequent analysis included demographic variables, case presentation, angiographic findings, treatment plan, and clinical outcomes.
Results: The search returned 147 articles after excluding duplicates. A review of the abstracts followed by full texts resulted in 16 articles that discussed a DAVF fed by the ADS, as identified by their respective authors. 28 patient cases were extracted from the articles. Among the patients retrieved, 55% were male and 45% were female. The mean age was 52.3 for females, 54.8 for males, and 53.6 overall.
Symptoms were heterogeneous for all cases, with the most common being headaches (12), mental status decline (6), tinnitus (4), and asymptomatic (2). All patients received an angiogram, which revealed the DAVF fed by the ADS. Of those reported, 1 DAVF was type I Borden/Cognard, 7 were type II, 7 were type III, and 6 were type III/IV. The DAVFs typically drained into multiple veins, with the most common venous drainage being the Galenic system (10), followed by the cortical vein (6), straight sinus (6), and vermian vein (4). They were most commonly treated with transarterial embolization in 22 out 28 cases. Observation was chosen in 2 cases, and surgical clipping in 2 others. The mean follow-up time was 19.16 months (2-72). 21 patients had complete resolution of their symptoms, 6 had partial resolve, and 1 had unchanged symptoms.
Conclusions: Cases of a DAVF fed by the ADS can present unique challenges, calling for a personalized approach to each patient guided by a thorough and precise understanding of the angioarchitecture of the artery to avoid complications, such as embolization reflux. The limited literature on this significant artery prompts further studies to aid in a better understanding of treatment options.