Persistent Primitive Olfactory Artery Research Articles

Normal Anatomy and Variants of the Anterior Cerebral and Anterior Communicating Arteries

The anterior cerebral artery(ACA)and anterior communicating artery(AcomA), two important arteries of the cerebral hemisphere, are involved in various disorders, including aneurysms, steno-occlusive diseases, and arteriovenous shunts, among other such conditions. Additionally, these vessels contain normal variants associated with their embryology and development. The ACA particularly shows characteristic variants such as a persistent primitive olfactory artery and an infraoptic course, among other such variations, which is attributable to the fact that it is embryologically older than the middle and posterior cerebral arteries. Aneurysm formation is associated with these variants. Therefore, knowledge of the normal anatomy and variants is important for diagnosis and treatment of conditions involving these arteries. In this article, we describe the normal anatomy and variants of the ACA and AcomA, focused on their embryological development.

Persistent Primitive Olfactory Artery Aneurysm

A middle-aged adult presented to the hospital with a high-grade aneurysmal subarachnoid hemorrhage. The patient was treated with endovascular coil embolization of a ruptured basilar tip aneurysm. Angiography demonstrated multiple other aneurysms, including type I persistent primitive olfactory artery aneurysm. After complete recovery and return to independence, the patient underwent elective treatment of the persistent primitive olfactory artery aneurysm with endovascular placement of a flow diversion stent. Persistent primitive olfactory artery is an extremely rare variant of the anterior cerebral artery with an incidence of 0.14% and a known increased risk of aneurysm formation.

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

Resection of olfactory groove meningiomas is challenging because of their close proximity with the anterior cerebral circulation. It is important to recognize the vascular variants in procedures at the anterior skull base because inadvertent maneuvers may result in the rupture of these arteries and unexpected bleeding. We reported a type 2 persistent primitive olfactory artery with a dural branch of the elongated anterior cerebral artery directly to the ethmoid region, visualized during the surgical removal of an olfactory groove meningioma. This is the first report of bilateral persistent primitive olfactory artery demonstrated by operative visualization and confirmed with vascular study. Understanding and recognizing the possible variations of this vascular anatomy is of great importance for anterior skull base surgeries.

Brain arteriovenous malformation involving a persistent primitive olfactory artery

The incidence of a persistent primitive olfactory artery is extremely rare. This anomaly may be involved in the development of aneurysms due to hemodynamic stress. We report a patient with a brain arteriovenous malformation mainly fed by a persistent primitive olfactory artery. A 40-year-old healthy man experienced transient numbness around the left side of his mouth. Magnetic resonance imaging incidentally disclosed flow voids inside and at the medial part of the pre-central gyrus of the left frontal lobe with dilation of the cortical veins. A left internal carotid artery angiogram revealed that a left persistent primitive olfactory artery with a proximal hair-pin turn fed an anterior component of the nidus. A right internal carotid artery angiogram showed that the right bihemispheric anterior cerebral artery fed a posterior component of the nidus. There was no aneurysm in the nidus or on the feeding vessel. The diagnosis was asymptomatic arteriovenous malformation (Spetzler-Martin grade 3). The patient developed systemic exanthema with facial edema after diagnostic angiography. We ruled out target embolization followed by stereotactic radiosurgery and placed him under close conservative outpatient observation. We suspect that the arteriovenous malformation was due to the presence of a pre-exiting persistent primitive olfactory artery. In patients with a persistent primitive olfactory artery, structural fragility and hemodynamic stress may elicit aneurysms at the apex of the hairpin curve of the persistent primitive olfactory artery.

Embryology of the anterior communicating artery complex: implications on possible adult variants

The anterior cerebral artery (ACA) and the anterior communicating artery (AComA) are important arteries of the telencephalon and are prominent location for cerebral aneurysms. Their embryological development is closely linked, and explains the possible variants seen in adults. In this paper, we present details related to the development of these two arteries, focusing on some variants such as the infra-optic course of the ACA, the unpaired ACA, and the persistent primitive olfactory artery.

Type 4 persistent primitive olfactory artery associated with contralateral accessory middle cerebral artery arising from the fenestrated segment of the distal anterior cerebral artery

Persistent primitive olfactory artery (PPOA) is a rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme anteroinferior course and takes a hairpin turn before continuing to the A2 segment of the ACA (type 1). There are four other types of extremely rare variations. The type 4 variation continues to the accessory middle cerebral artery (MCA) instead of the ACA. Only a few cases have been reported. We herein report a case of type 4 PPOA in which the contralateral side of the accessory MCA arose from the fenestrated segment of the distal ACA. No similar cases were found in the relevant English-language literature. For the identification of these variations on MR angiography, volume-rendering images were superior to maximum-intensity-projection images.

Bilateral persistent primitive olfactory artery incidentally detected by computed tomography angiography and digital subtraction angiography: An extremely rare case report

Bilateral persistent primitive olfactory artery incidentally detected by computed tomography angiography and digital subtraction angiography: An extremely rare case report

Persistent Primitive Olfactory Artery as Novel Collateral Channel to the Anterior Cerebral Artery in Moyamoya Disease

Background: There are a variety of collateral routes to compensate persistent cerebral ischemia in moyamoya disease. However, there is no report presenting the persistent primitive olfactory artery (POA) as a spontaneous collateral route to the anterior cerebral artery (ACA) in moyamoya disease. Methods: We precisely examined cerebral angiography in 84 patients with moyamoya disease to identify the collateral channel through the persistent POA. Its anatomy was evaluated on pre- and postoperative angiography. Results: Of 84 patients, four (4.8%) had spontaneous collateral channel through the persistent POA. All of these four hemispheres were categorized into Stage 5. In all four patients, the collateral blood flow arose from the ophthalmic artery and run to the persistent POA through the ethmoidal moyamoya. The persistent POA provided collateral blood flow from the ophthalmic artery to the ACA in all four patients. Superficial temporal artery to middle cerebral artery anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis was performed in three of four patients. After surgery, the collateral channel through the persistent POA completely disappeared or markedly regressed, suggesting a significant improvement of cerebral hemodynamics in the territory of not only the MCA but also the ACA. Conclusion: The persistent POA can potentially provide collateral blood flow to the ACA in about 5% of patients with moyamoya disease, and should be recognized as a novel collateral channel in moyamoya disease. The persistent POA may be useful to evaluate therapeutic effects of surgical revascularization on the ACA territory.

An Adult Case of Noonan Syndrome Associated with Persistent Right Primitive Olfactory Artery and Vertebrobasilar Artery Hypoplasia

An Adult Case of Noonan Syndrome Associated with Persistent Right Primitive Olfactory Artery and Vertebrobasilar Artery Hypoplasia

Agenesis of the Corpus Callosum Associated with Persistent Primitive Olfactory Artery - Case Report and Literature Review

Agenesis of the corpus callosum (ACC) is a congenital malformation that can occur in isolation or in association with other neurological conditions. However, to our knowledge, no cases of ACC associated with persistent primitive olfactory artery (POA) have been reported.

Persistent primitive olfactory artery: CT angiographic diagnosis and literature review for classification and clinical significance

The aim of this study was to investigate the incidence of a persistent primitive olfactory artery (POA) and to review the literatures focusing on the classification and clinical significance of this variant. To identify cases with persistent POA, we reviewed the records of computed tomography (CT) angiography performed on 3,067 patients in our institution from January 1, 2011 to August 31, 2013. Literatures on the incidence and classification of a persistent POA were reviewed. Among these patients, eight were diagnosed with a persistent POA (five men, three women, aged 44-82years), an incidence of 0.26%. Six persistent POAs terminated as a distal anterior cerebral artery (ACA) and two as a distal middle cerebral artery. Previous studies applied similar definitions for the classification of persistent POA; however, there has been confusion on the definition of variant 2. In our institution, the incidence of persistent POA seen on CT angiography was 0.26%. An artery with its embryological course along the olfactory bulb should be classified as a persistent POA and differentiated from dural artery from ACA.

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

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.

Persistent primitive olfactory artery in Serbian population.

The continuation of the cranial branch of the primitive internal carotid artery is called the primitive olfactory artery (POℓA). It takes this name according to the fact that it is mainly concerned with supplying the developing nasal region. We reported two new cases of the persistent POℓA (PPOℓA) in Serbian population after retrospective analysis of digital images of 200 fetal and 269 adult cases. This PPOℓA originated from the precommunicating part (A1) of the right anterior cerebral artery, coursed along the olfactory tract, and turned on the medial cerebral hemisphere in both male adults. Some vascular variations (fenestration of the A1 and the median artery of the corpus callosum) were associated with this persistent vessel. According to the fact that we did not find aneurysm in our previous and two recent cases, we are of the opinion that PPOℓA is usually asymptomatic in Serbian population.

New variant of persistent primitive olfactory artery associated with a ruptured aneurysm

The authors present the case of a 78-year-old man who presented with a subarachnoid hemorrhage due to rupture of an aneurysm at the origin of the persistent primitive olfactory artery (PPOA). Interestingly, the PPOA was originating from the A1 segment of the anterior cerebral artery and coursed anteromedially along the olfactory tract. Moreover, the PPOA in this case had 2 branches: the branch making a hairpin turn and supplying the distal part of the anterior cerebral artery territory (Type 1), and the branch extending to the cribriform plate to supply the nasal cavity (Type 2). To the best of the authors' knowledge, this is a new variant (Type 3) of PPOA associated with a ruptured aneurysm. The clinical implications of this case are discussed in terms of the embryological aspects.

Magnetic Resonance Angiography and CT Angiography of Persistent Primitive Olfactory Artery: Incidence and Association Rate with Aneurysm in Korea

Copyrights © 2012 The Korean Society of Radiology Purpose: Japanese data indicates an incidence of persistent primitive olfactory artery (PPOA) of 0.14%. We studied the incidence of PPOA and associated cerebral vascular variation or anomalies in Korea. Materials and Methods: We retrospectively reviewed cranial magnetic resonance angiography (MRA) and computed tomography angiography (CTA) images of a total of 9841 patients of our institution. The diagnostic criterion of PPOA is extreme anterioinferior course of the proximal anterior cerebral artery, with a hairpin turn of the lateral projection. Results: We found 29 cases (0.29%) with PPOA. The PPOA location was on the left in 19 cases, bilateral in 3 cases, and on the right in 7 cases. An aneurysm was found at the hairpin turn in 2 patients. There were aneurysms in other sites in 3 cases. There were hypoplasia of anterior cerebral artery in 3 cases, and fenestration of intracranial artery in 1 case. Conclusion: In Korean populations, the incidence of PPOA found in MRA and CTA was twice as high as that shown in the previous Japanese data. Within Korea, left side laterality is more common than right side or bilalterality. Aneurysmal dilatations at the hairpin turning point and aneurysms at other sites were found, and other vascular variations were observed in several cases. Index terms Persistent Primitive Olfactory Artery Aneurysm Angiography Magnetic Resonance Angiography and CT Angiography of Persistent Primitive Olfactory Artery: Incidence and Association Rate with Aneurysm in Korea 잔류 원시 후각동맥의 자기공명 및 전산화단층촬영 혈관조영술 소견: 한국인에서의 빈도와 동맥류와의 연관성

Persistent primitive olfactory artery

I have read with great interest the paper recently published in your journal by Uchino et al. [5] describing the persistent primitive olfactory artery (POA). In the anatomical paper on cerebral arteries, two important points are required. One is description of the detailed arterial anatomy (static anatomy). In this sense, new information of the incidence of the POA being 0.14% and no laterality is provided. Another important point is embryological description to facilitate understanding of the anatomy and its variations (functional anatomy). In the latter sense, there is a serious misunderstanding of the POA in this paper, as well as the preceding papers [2, 4]. In these papers, it is described that the remnant of the POA is the recurrent artery of the Heubner (RAH), all of which quoted Padget’s paper inappropriately [3]. Embryologically, the early brain vesicles are supplied by the primitive internal carotid artery, which is further divided into the rostral and caudal divisions (Fig. 1). The rostral division supplies the prosencephalon (rhinencephalon in lower vertebrates, thus the artery is called the olfactory artery), and constitutes the POA [3]. The POA terminates in the nasal fossa and the secondary artery constitutes the medial olfactory artery, which supplies the olfactory bulb (Fig. 2). The medial olfactory artery becomes the anterior cerebral artery proper, while the terminal portion of the POA usually regresses. Lateral olfactory branches of the POA include the RAH, anterior choroidal artery, lateral striate artery, and later middle cerebral artery [1] (Fig. 3). When the terminal portion of the POA does not regress, it is called the persistent POA. There are two types of the persistent POA [2]: type 1 artery has a hairpin turn along the olfactory bulb coursing postero-superiorly to become the distal anterior cerebral artery, and type 2 artery enters the nasal cavity and connects with the ethmoidal artery (Fig. 4). Type 2 artery is homologous to the internal ethmoidal artery in dogs. The RAH is an old branch of the lateral olfactory branches of the POA, supplying the rostral corpus striatum and internal capsule, which are completely different from the olfactory lobe. Embryologically, the POA is the rostral division of the primitive internal carotid artery. The POA constitutes the anterior cerebral artery proper, and when the POA keeps its

Diagnosis of Persistent Primitive Olfactory Artery Using Computed Tomography Angiography

Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA.

Persistent primitive olfactory artery: MR angiographic diagnosis

Persistent primitive olfactory artery (PPOA) is a relatively rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme antero-inferior course and takes a hairpin turn. To our knowledge, incidence of PPOA has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on MR angiography. To isolate cases with PPOA, we retrospectively reviewed cranial magnetic resonance (MR) angiographic images of a total of 3,626 patients in our institution and collected similar images from cases with PPOA from our two affliated hospitals. We found 14 cases with PPOA (six men and eight women); 5 patients in our institution, representing an incidence of 0.14%, and 9 cases from our group hospitals. The location was on the right in six cases, left in seven, and bilateral in one. An aneurysm was found at the hairpin turn in one patient, and in another patient, the PPOA connected with the accessory middle cerebral artery (MCA) and not the distal ACA. In our institution, incidence of PPOA on MR angiography was 0.14%. We found no laterality in frequency and rare bilaterality, aneurysm at the point of the hairpin turn, and accessory MCA arising from the PPOA.

Mixed Pial-Dural Arteriovenous Malformation in the Anterior Cranial Fossa -Two Case Reports-

Most arteriovenous malformations (AVMs) associated with the meningeal artery in the anterior cranial fossa are the pure dural type, and mixed pial-dural AVMs are rare. Two types of mixed pial-dural AVM occur in the anterior cranial fossa according to the shunting point: one with the nidus in the brain parenchyma of the frontal lobe, and the other with the shunting point in the dura mater. We describe two patients with AVMs fed by the anterior ethmoidal arteries and the persistent primitive olfactory artery, with the nidus located in the pure brain parenchyma of the inferior aspect of frontal lobe, and drained via an abnormal cortical vein into the cavernous and superior sagittal sinuses. The importance of occluding the venous outflow to obliterate intracranial dural arteriovenous fistula (AVF) is emphasized. However, removal of the nidus in the brain parenchyma is required. The presence of a pial feeder should be considered before diagnosis of dural AVF of the anterior cranial fossa, and preoperative detailed evaluation for the pial supply and shunting point is mandatory.

Agenesis of the Right Internal Carotid Artery Associated with Persistence of the Primitive Olfactory Artery. A Case Report.

Unilateral agenesis of the internal carotid Artery (ICA) is an extremely rare developmental anomaly. The absence of an ICA was first described by Tode in 1787 after being discovered during a postmortem examination. Only approximately 100 cases have been reported in the literature with a left predominance (3:1). When a unilateral ICA is absent, collateral circulation is sufficient to maintain cerebral function with few or no neurologic symptoms. Most patients with ICA agenesis present with focal neurologic signs, such as convulsions, headache, or transient ischemic attack, and ICA agenesis may be associated with aneurysm, hemorrhage, cerebral Hypoplasia, hemangioma, or anomalous vascular anastomosis. During dissection carried out in the Anatomy laboratory an absence of the right internal carotid artery was found. The specimen consists of a brain from a male cadaver with absence of the right internal carotid artery. A common trunk arises from the anterior aspect of the left internal carotid artery to supply the territory corresponding to the right internal carotid artery. Just anterior to the right middle cerebral artery this common trunk gives rise to two small vessels and then splits into two terminal branches. These two small vessels probably correspond to a persistent primitive olfactory artery (PPOA, embryological vessel). Six different branching patterns of circulation in cases of absence of internal carotid artery have been described for many authors; this paper describes a branching pattern of circulation previously undescribed.