A unique variant of a persistent trigeminal artery combined with an accessory anterior cerebral artery

The cerebral arterial circle exhibits considerable variability with clinical relevance in radiological and neurosurgical practice. Among its rarest variants are persistent embryonic arteries, notably the persistent trigeminal artery (PTA). We present a unique case identified via magnetic resonance angiography (MRA) in a 39-year-old female, revealing a PTA giving rise to the anterior inferior cerebellar artery (AICA). An accessory anterior cerebral artery (aACA) emerged from the anterior communicating artery. The coexistence of these two rare variants forms a peculiar arterial pattern. Interestingly, the AICA origin from the PTA is a scarce variation. This case highlights the importance of detailed vascular imaging for identifying atypical configurations, which may influence surgical approaches and risk assessment in cerebrovascular procedures.