# Anomalous Origin of the Artery of Davidoff and Schechter Confirmed in a Case of Dural Arteriovenous Fistula of the Superior Sagittal Sinus

## TL;DR

A rare case confirms an unusual origin of the artery of Davidoff and Schechter in a dural arteriovenous fistula, highlighting the need for detailed angiographic evaluation.

## Contribution

This case confirms an anomalous origin of the artery of Davidoff and Schechter from the P4 segment of the PCA in a dural AVF.

## Key findings

- Angiography revealed a dural branch from the left P4 of the PCA feeding into the shunt.
- Endovascular embolization significantly reduced shunt blood flow without complications.
- ADS anomalies are poorly understood due to their low visibility in healthy individuals.

## Abstract

Objective: The artery of Davidoff and Schechter (ADS) is a dural branch originating from the second segment of the posterior cerebral artery (PCA). ADS may not be discernible even with angiography and is identified when it develops as a feeder in arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs), or tumors. Herein, we describe a case of dural AVF of the superior sagittal sinus (SSS) that caused seizures.

Clinical presentation: A 72-year-old woman had a seizure caused by a dural AVF at the SSS with the bilateral middle meningeal and occipital arteries as major feeders and marked reflux into the bilateral cortical veins via bridging veins. The angiography revealed a dural branch from the left fourth segment (P4) of the PCA entering the falx via the medial surface of the cerebellar tentorium and feeding into the shunt, which was thought to be the anomalous origin of the ADS. Endovascular embolization resulted in a significant reduction in shunt blood flow with no complications.

Conclusion: Angiography revealed feeders from an exceedingly rare variant of ADS branching from the P4 of the PCA. Comprehending the incidence and characteristics of ADS anomalies remains inadequate because of their poor visibility in angiographic examinations of healthy individuals. Typically, the ADS supplies only the dura mater; however, it can also have branches that extend to the brain parenchyma. Thus, thorough angiographic evaluation is essential when addressing conditions in falcotentorial regions that involve ADS.