Arteriovenous Fistula Arising From the Persistent Primitive Olfactory Artery With Dual Supply From the Bilateral Anterior Ethmoidal Arteries -Case Report-

Abstract

A 59-year-old male presented with generalized seizure. The patient had not been aware of any traumatic head injuries or preceding infection, and had no contributory medical history. On admission, he was alert and well oriented, without neurological impairment or headache. He was afebrile and blood examination showed no abnormal findings. Computed tomography revealed an irregular intracerebral hematoma, 3 × 1.5 cm in diameter, in the left rectal gyrus. Cerebral angiography showed an arteriovenous fistula (AVF) in the anterior cranial fossa supplied only by the persistent primitive olfactory artery (PPOA) originating from the anterior cerebral artery, forming a shunt to an ascending cortical vein, and drained by the superior sagittal sinus. The patient underwent endovascular obliteration of the AVF via the transarterial route. Immediately after successful isolation, angiography showed that the bilateral anterior ethmoidal arteries supplied the AVF. The feeding branches from the left anterior ethmoidal artery were completely occluded via the ophthalmic artery, but introduction of the catheter into the right ophthalmic artery markedly decreased the stump pressure. Follow-up angiography performed at 3 and 8 weeks following embolization showed spontaneous resolution of the residual AVF without findings of recanalization or new abnormal channels. AVF arising in the anterior cranial fossa may be associated with an unusual pattern of the blood supply when including the PPOA.

Persistent Primitive Olfactory Artery in Serbian Population

“…In addition, we could compare the origin of PPO ℓ A from the A1 part in these cases with the PO ℓ A origin in an 18 mm human embryo whose picture was displayed in the paper by Katayama et al [14]. Tsutsumi et al [8] described that PPO ℓ A originated from A1-A2 junction. However, many authors described its internal carotid origin [7, 9, 14, 16, 19, 21].…”

“…Firstly, we noted some data and disagreements in the literature about the PO ℓ A origin [1, 6, 25], PO ℓ A rudiments [1] or a lack of embryologic explanation of A1 variable side branches [15, 26], as well as an origin [20] or termination [8, 15] of the PPO ℓ A. …”

“…In our “third” type, the PPO ℓ A of the MCA origin had a common trunk with posterior communicating artery (PCoA) and coursed forward to the ipsilateral olfactory tract [22]. The case of the PPO ℓ A termination (PPO ℓ A—cortical frontal vein shunt) described by Tsutsumi et al [8] was classified as type 4. …”

“…Some authors noted that PO ℓ A normally regresses to the remnant—the recurrent artery of Heubner (RAH) [4, 5]. Other authors supported this claim by the evidence of an aplasia of the RAH [6–8] and/or the anterior communicating artery [6, 9]. …”

Persistent primitive olfactory artery connected with middle cerebral artery: case report

“…In PPOA variant 2, the artery arises from the normal A1 and passes through the cribriform plate to supply the nasal cavity as the ethmoidal artery. Three cases of PPOA variant 2 have been reported, in all of whom a normal A1 was present [ 1 , 5 , 7 ].…”