Concomitance of persistent primitive olfactory artery, accessory middle cerebral, and early bifurcated anterior cerebral arteries

The cerebral arterial circle is susceptible to various developmental anomalies that may persist in adulthood. Notably, the persistent primitive olfactory artery (PPOA) is a rare variation, with a reported prevalence of 0.14%, and it is infrequently paired with other vascular anomalies. This imaging report details a unique instance involving a 65-year-old male patient presenting a rare combination of a left-sided PPOA, a left-sided accessory middle cerebral artery (AMCA), and an early bifurcation of the anterior cerebral artery (ACA). The arterial variations were identified utilizing computed tomography angiography (CTA). The PPOA, characterized by its distinctive hairpin turn and nasal branch, runs parallel to the A2 segments, while the AMCA emerges as an anomalous branch from the ACA. Comprehending such configurations is essential for preoperative planning in anterior skull base surgeries due to the associated risks of aneurysm formation and potential intraoperative complications. This case underscores the significance of recognizing rare vascular anomalies to mitigate surgical risks and enhance patient outcomes.