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

Abstract

A persistent primitive olfactory artery (PPOA) is an extremely rare variation of the proximal anterior cerebral artery (ACA). The PPOA is connected to the distal ACA, ethmoidal artery, or both. I describe one patient with a PPOA connected to the middle cerebral artery (MCA). I analyzed the radiological characteristics of this anomalous vessel in this patient, who presented with headache. Computed tomography-angiography revealed an abnormal vessel in the patient, which originated from the distal ACA and ran anteromedially along the olfactory tract; it then made an abrupt turn and became the MCA. A PPOA connected to the MCA has been described in only two patients, including my own, in the English-language literature.

Normal pio-dural arterial connections

“…Type 4 arises from the A1 segment and initially courses along the olfactory tract before turning back and taking on the role of an accessory MCA. 11…”

Bilateral Persistent Primitive Olfactory Arteries Observed During Resection of Olfactory Groove Meningioma: Technical Case Report

“…6 Nozaki et al 5 initially described this first type of PPOA as type 1, while in type 2, the artery arises from the ACA and passes through the cribriform plate to supply the nasal cavity by anastomosing with the ethmoidal arteries. 5,7,8 Other types have subsequently been described: type 3 PPOA has the characteristic appearance of both type 1 and type 2, with the callosomarginal artery originating distally from the PPOA, after the emission of an ethmoidal branch 7,9 ; type 4 connects to the accessory middle cerebral artery instead of the distal ACA 6,10,11 ; type 5 continues to the A3 segment of the ACA without a hairpin turn 12 ; and, in the more recently proposed type 6, the orbitofrontal artery originates from the hairpin turn, instead of the A2 13 (Figure 1).…”