Eponyms in Vascular Neurosurgery: Comprehensive Review of 11 Arteries

Ruptured aneurysm of the artery of Davidoff and Schechter: illustrative case

BACKGROUND

The artery of Davidoff and Schechter (ADS) is an uncommonly encountered meningeal branch originating from the posterior cerebral artery typically identified in the setting of pathology, often dural arteriovenous fistulas (DAVFs). Here, the authors describe the first reported case of an ADS aneurysm, discovered in the setting of subarachnoid hemorrhage (SAH) and complicating a high-grade DAVF.

OBSERVATIONS

A 57-year-old female presented after experiencing the worst headache of her life. Noncontrast computed tomography scanning of the head demonstrated SAH. Angiography revealed a high-grade DAVF centered around the anterior straight sinus, consistent with the Galenic subtype of tentorial DAVF. Predominant arterial supply was from the bilateral middle meningeal and occipital arteries. Vertebral artery imaging revealed a 12-mm irregular aneurysm. The prospect that the target artery represented the noneloquent ADS was confirmed by Wada testing. Given the fusiform nature of the aneurysm, treatment required concomitant coil embolization of the aneurysm and parent artery sacrifice. A week later, the DAVF was treated with liquid embolic. The patient tolerated treatment without neurological compromise.

LESSONS

The authors describe the first reported case of an ADS aneurysm discovered in the setting of SAH complicating a high-grade DAVF and the lessons learned during our experience managing this unique pathology.

NOMENs land: The place of eponyms in the anatomy classroom

The law of Non-Original Malappropriate Eponymous Nomenclature (NOMEN) states that no phenomenon is named after its discoverer. However, eponymous terms are rife in the anatomical and medical literature. In this viewpoint commentary, the authors discuss the history of anatomical eponyms, explain the additional cognitive load imposed by eponyms that can negatively impact student learning and explore the view that eponyms are "pale, male and stale" in the socially conscious 21st century. The authors probe two of the most common arguments used to keep eponyms in anatomy education: (1) clinicians use them because they are easy, and (2) eponyms remind us of anatomy's history. Educators, clinicians and students need to work together to progress this movement and bring a modern lens to this discussion. Based on the arguments presented in this commentary, the authors propose that eponyms should be removed from anatomy curricula, textbooks and have no place in the anatomy classroom.

Spontaneous resolution of a tentorial dural arteriovenous fistula fed by the artery of Wollschlaeger and Wollschlaeger after embolization of the main shunting point

Background

Tentorial dural arteriovenous fistula (TDAVF) is a rare intracranial vascular shunt. A TDAVF can be supplied by the Artery of Wollschlaeger and Wollschlaeger (AWW). However, a limited number of cases of TDAVF fed by the AWW have been reported to date.

Case Description

A 70-year-old woman complaining of the right motor weakness underwent magnetic resonance imaging. A vascular lesion beneath the cerebellar tentorium was incidentally found with chronic infarction of the left corona radiata. Angiographically, the vascular lesion was a TDAVF supplied by the bilateral posterior meningeal arteries. No other apparent feeders were detected. The TDAVF had a shunting point on the inferior surface of the cerebellar tentorium with venous retrograde flow (Borden type III, Cognard type III). To prevent vascular events, endovascular embolization was performed using n-butyl-2-cyanoacrylate. Following embolization of the shunting point, a residual shunt fed by the AWW was identified. The shunt supplied by the AWW was not observed preoperatively. Follow-up angiography performed 1 week later revealed spontaneous disappearance of the residual shunt. The patient was followed-up in our outpatient clinic, and no recurrence of the TDAVF was confirmed postoperatively.

Conclusion

Detection of mild feeding from the AWW to a TDAVF can be elusive preoperatively. Following embolization of the main shunting point, residual shunting from the AWW can resolve spontaneously.