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At least 325 records · Page 18Linked to original sources
PubMed2002

Fenestrated stent-graft for traumatic juxtahepatic inferior vena cava injury.

PURPOSE: To report the use of a fenestrated stent-graft to manage a traumatic rupture of the juxtahepatic inferior vena cava (IVC). CASE REPORT: A 62-year-old man was involved in a traffic accident and hospitalized for severe right leg fractures. Computed tomography also uncovered liver contusion and retroperitoneal hematoma. The next day, he became hemodynamically unstable; a huge retroperitoneal hematoma had developed from a rupture of the juxtahepatic IVC. An emergent procedure to implant a self-expanding fenestrated stent-graft was successful in repairing the IVC injury and maintaining hepatic venous return. The patient recovered and continues in good health with a patent endograft 16 months after treatment. CONCLUSIONS: This experience supports the efficacy of fenestrated endograft implantation for emergent repair of IVC injuries, although proper facilities, an experienced interventional team, and an assortment of devices must be available.

Accidents, Traffic↗
PubMed1998

Fenestration of porencephalic cysts to the lateral ventricle: experience with a new technique for treatment of seizures.

BACKGROUND: Porencephalic cysts are brain cavities resulting from perinatal vascular occlusion and are commonly associated with severe neurological deficits and medically intractable epilepsy. Thirty-seven children presenting to the University of Münster with intractable seizures because of a porencephalic cyst were treated by uncapping and fenestration of these cysts to the lateral ventricle between 1978 and 1992. We conducted the following study to determine the efficacy and safety of the uncapping and fenestration procedure for the treatment of seizures. METHODS: We reviewed all cases retrospectively and assessed the outcome of these patients with regard to seizures, paresis, and perioperative complications. RESULTS: Of 37 children, 23 (62%) were seizure-free postoperatively. Nine patients (24%) had a reduction of seizures and five children (14%) remained unchanged. Of 30 patients with preoperative hemiparesis, 11 (30%) improved after the operation. The leading postoperative problem was a subcutaneous/subgaleal cushion of CSF, which affected 12 children (12 of 37). A dural patch covering the iatrogenic dural defect could not prevent or reduce postoperative CSF leakage, but prolonged the postoperative fever period. Postoperative fever occurred in 36 children (36 of 37) and was caused by an aseptic meningitis. CONCLUSIONS: Children with intractable seizures and porencephalic cysts benefit from uncapping and cyst fenestration to the lateral ventricle. Concomitant perioperative complications are mild and are easily treated.

Adolescent↗
PubMed1988

To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?

The treatment options for intracranial arachnoid cysts are either craniotomy and fenestration of the cyst into the cerebrospinal fluid spaces or shunting of the cyst contents extracranially. Fenestration may eliminate the need to shunt, but it is a major operative procedure and is not always successful. To determine which treatment provides the greatest benefit with the fewest complications, the records of 31 patients with 34 arachnoid cysts treated at the Children's Hospital of Los Angeles between 1976 and 1986 were reviewed. The mean age of the patients was 4.4 years, with a range of 0 to 15.5 years. The most common location was the middle fossa (14 cases), followed by the posterior fossa (7 cases), the suprasellar region (5 cases), and hemispheric (5 cases) and other locations (3 cases). Signs and symptoms were related to abnormally rapid head growth in infants and to increased intracranial pressure and seizures in older children. The initial treatment of 29 cysts was fenestration. Twenty-two (76%) procedures were successful, with no additional treatment needed for the cyst. The other 7 cysts required the subsequent placement of a cystoperitoneal shunt. In 5 cases, the cysts were treated initially with cystoperitoneal shunts. Of the total 12 cystoperitoneal shunts, 5 have required revisions on one or more occasions. No significant difference in morbidity was noted between the two treatment options. Because we consider shunt independence to be a major goal of therapy, we suggest that patients with arachnoid cysts be divided into two categories, those presenting with associated hydrocephalus and those without hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Cerebral arterial fenestrations associated with intracranial saccular aneurysms.

Fenestrations of cerebral arteries other than the anterior communicating artery are rare congenital anomalies, which may be associated with saccular aneurysms. In such cases, the aneurysms may be located at the fenestration itself or may involve other intracranial vessels. This kind of association is not infrequently the cause of angiographic diagnostic problems, as well as surgical difficulties, and consequently needs to be well known to physicians. Four recent cases of rare fenestrations of cerebral arteries associated with intracranial aneurysms are reported in this study and discussed together with a review of the literature.

Adult↗
PubMed2006

Endoscopic fenestration of a symptomatic cavum septum pellucidum: technical case report.

OBJECTIVE: Cysts of the septum pellucidum (CSPs) may become symptomatic because of obstruction of cerebrospinal fluid flow, resulting in increased intracranial pressure and hydrocephalus requiring surgical intervention. Endoscopic fenestration may be the most effective and least invasive technique to treat this pathological condition. CLINICAL PRESENTATION: An 11-year-old boy sought treatment for frequent episodes of severe headache. On examination, he had papilledema. There was evidence on magnetic resonance imaging scans of a space-occupying CSP with obstructive hydrocephalus. INTERVENTION: The endoscopic technique of fenestration of both lateral walls of an enlarged CSP via a left frontal approach under ultrasound guidance using a rigid endoscope was successful. After surgery, the patient became asymptomatic, his papilledema resolved, and magnetic resonance imaging scans demonstrated collapse of the walls of the CSP toward the midline. CONCLUSION: Neuroendoscopic fenestration should be strongly considered as the treatment of choice for symptomatic CSPs. This procedure alone can lead to complete resolution of clinical symptoms and hydrocephalus, can reduce the size of the CSP, and can obviate the need for an implantable cerebrospinal fluid shunt.

Brain Diseases↗
PubMed1999

Fenestration nodes and the wide submyelinic space form the basis for the unusually fast impulse conduction of shrimp myelinated axons.

Saltatory impulse conduction in invertebrates is rare and has only been found in a few giant nerve fibres, such as the pairs of medial giant fibres with a compact multilayered myelin sheath found in shrimps (Penaeus chinensis and Penaeus japonicus) and the median giant fibre with a loose multilayered myelin sheath found in the earthworm Lumbricus terrestris. Small regions of these nerve fibres are not covered by a myelin sheath and serve as functional nodes for saltatory conduction. Remarkably, shrimp giant nerve fibres have conduction speeds of more than 200 m s-1, making them among the fastest-conducting fibres recorded, even when compared with vertebrate myelinated fibres. A common nodal structure for saltatory conduction has recently been found in the myelinated nerve fibres of the nervous systems of at least six species of Penaeus shrimp, including P. chinensis and P. japonicus. This novel node consists of fenestrated openings that are regularly spaced in the myelin sheath and are designated as fenestration nodes. The myelinated nerve fibres of the Penaeus shrimp also speed impulse conduction by broadening the gap between the axon and the myelin sheath rather than by enlarging the axon diameter as in other invertebrates. In this review, we document and discuss some of the structural and functional characteristics of the myelinated nerve fibres of Penaeus shrimp: (1) the fenestration node, which enables saltatory conduction, (2) a new type of compact multilayered myelin sheath, (3) the unique microtubular sheath that tightly surrounds the axon, (4) the extraordinarily wide space present between the microtubular sheath and the myelin sheath and (5) the main factors contributing to the fastest impulse conduction velocity so far recorded in the Animal Kingdom.

Animals↗
PubMed1993

The role of fenestrated vessels for the secretory process in the nasal mucosa: a histological and transmission electron microscopic study in the rabbit.

Both nasal glands and nasal vessels are supposed to be responsible for the humidification of inhaled air. After previous studies on the vasculature of the nasal septal mucosa in the rabbit, we examined vessels of the anterior concha in order to find a morphological equivalent to explain the role of endonasal vasculature in the secretory process of this tissue. The main findings of our study include the detection of fenestrated endothelial walls of both capillaries and venous sinuses located underneath and directly adjacent to the basal cell layers of the epithelium. The same phenomenon-fenestrated vessels underneath the epithelium with the fenestrated parts facing the epithelial cells-has been described in other parts of the body and has been called "polar differentiation." In accordance with the interpretations of other authors, we conclude that these features are responsible for the regulation of endonasal fluid exchange.

Animals↗
PubMed1977

Gingival fenestration.

A pathologic entity, the gingival fenestration, has been described. The lesion is seen infrequently in clinical practice, probably due to the short time span of its existence and the lack of acute symptoms. It is possible that it occurs with greater frequency than generally realized. A hypothesis is presented as to the method of formation of the gingival fenestration and it is suggested that the area should be treated as gingival recession extending to the apical border of the fenestration.

Gingival Diseases↗
PubMed1991

Fenestration of the intracranial internal carotid artery--case report.

A rare case of fenestration of the intracranial internal carotid artery (ICA) was identified by angiography in a 51-year-old female with suspected subarachnoid hemorrhage. Only two similar cases have been reported previously. Fenestration tends to develop on the right side and near the bifurcation of the ophthalmic artery. Congenital factors at the 4 mm embryonic stage may be involved in the fenestration of the intracranial ICA.

Carotid Artery, Internal↗
PubMed1993

Fenestration of the internal carotid artery associated with an ischemic attack--case report.

A rare case of fenestration or duplication of the internal carotid artery occurring in a 73-year-old male associated with ischemic attack is reported. Carotid angiography demonstrated the fenestration associated with coiling in the left internal carotid artery. He was treated conservatively. The ischemic attack was probably due to a thrombus or embolus from the fenestration.

Aged↗
PubMed1998

Fenestration of the proximal anterior cerebral artery (A1) with aneurysm manifesting as subarachnoid hemorrhage--case report.

A 50-year-old female presented with rare fenestration of the proximal anterior cerebral artery (A1 segment). This rare congenital anomaly was associated with an aneurysm at the proximal end of A1 fenestration causing subarachnoid hemorrhage, and aplasia of the contralateral A1 segment. Surgical treatment to clip the aneurysm resolved her symptoms. Hemodynamic stress at the arterial fenestration probably caused the aneurysm, possible induced by aplasia of the contralateral A1 segment.

Aneurysm, Ruptured↗
PubMed1996

Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery. Case report and literature review.

Fenestration of the proximal anterior cerebral artery (A1 segment) is a rare occurrence. This vascular anomaly is often associated with aneurysms and other abnormalities. The current article describes the case of a 33-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm originating from the proximal end of an A1 fenestration. This patient also had a contralateral A1 fenestration as well as an azygos anterior cerebral artery. This is the first report of such an unusual vascular anatomy. The literature is reviewed and possible embryological mechanisms are discussed.

Adult↗
PubMed2000

Origin of the Drake fenestrated aneurysm clip.

The development of the Drake fenestrated aneurysm clip is a study in the history of ideas. This communication outlines the conception and solution of a surgical problem involved with the clipping of large basilar tip aneurysms. Dr. Charles G. Drake's ability to modify old ideas and experiment with new ones was instrumental to the conceptual idea of a fenestrated clip. Dr. Frank H. Mayfield and Mr. George Kees, Jr. played essential roles in bringing the idea to a reality. The development of the fenestrated clip has added substantially to the armamentarium of the aneurysm surgeon in dealing with large and complex aneurysms.

Canada↗
PubMed2004

Ruptured aneurysm arising from a basilar artery fenestration and associated with a persistent primitive hypoglossal artery. Case report and review of the literature.

A 42-year-old woman experienced the sudden onset of a severe headache. Angiograms demonstrated a persistent primitive hypoglossal artery (PHA) originating from the internal carotid artery at the C-2 vertebral level. In addition, a fenestration at the PHA-basilar artery (BA) junction and an aneurysm at the proximal end of this fenestration were revealed. To perform endovascular embolization of the aneurysm, a microcatheter was introduced into the aneurysm sac via the PHA and two Guglielmi Detachable Coils were placed in the aneurysm. The patient's postoperative course was uneventful, and she was able to resume her normal life. Although many clinical cases have been reported in which a ruptured aneurysm was associated with a PHA or a BA fenestration, as far as the authors know there has been no case in the literature in which a ruptured aneurysm associated with both anomalies and no case in which endovascular embolization was used to treat a ruptured aneurysm associated with a PHA. This rare case is discussed and a review of the relevant literature is presented.

Adult↗
PubMed2005

Endoscopic fenestration and coagulation shrinkage of suprasellar arachnoid cysts. Technical note.

The authors describe their experience with endoscopic fenestration of suprasellar cysts followed by shrinkage coagulation of the cysts to restore the anatomy in eight patients. Seven children ranging in age from 8 months to 4.5 years and one adult 24 years of age were treated. Four of the children presented with megacephaly and the other patients with malfunction of a shunt that had been placed previously for hydrocephalus. Endoscopic fenestration of the cyst dome was performed followed by shrinkage of the lesion by means of endoscopic coagulation. Follow-up studies included immediate and late postoperative magnetic resonance imaging, assessment of growth velocity and the body mass index (BMI), and an endocrine profile if indicated by a failure of growth or precocious puberty. Good intraoperative cyst shrinkage was achieved in all seven children. This was maintained on imaging studies at a mean follow-up period of 35 months. There was no significant procedure-associated morbidity. Hydrocephalus resolved in four patients who did not have a preexisting shunt. One of the four patients who had a shunt preoperatively became shunt free. The rest of the patients with preexisting shunts remained shunt dependent despite good resolution of the cyst. During a mean follow-up period of 52 months, the height, growth velocity, and BMI of each patient remained within two standard deviations of normal. In one patient there was a suspicion of precocious puberty, but the endocrine profile was normal; in another patient precocious puberty developed and required treatment. The presented technique is safe and prevents cyst recurrence and obstruction of the aqueduct by remnants of the cyst wall-the two main reasons for failure of a simple endoscopic fenestration.

Adult↗
PubMed2004

Combined hepatic resection with fenestration for highly symptomatic polycystic liver disease: A report on seven patients.

AIM: To evaluate the immediate and long-term results in a series of patients with highly symptomatic polycystic liver disease (PLD) treated by combined hepatic resection with cystic fenestration. METHODS: We reviewed our recent experience with a combined hepatic resection-fenestration procedure in seven highly symptomatic patients with PLD. Clinical data, liver manifestation of computed tomography (CT), and morbidity were recorded pre- and post-operation. Follow-up was made by clinical and CT examinations in all patients. RESULTS: Symptomatic relief and reduction in abdominal girth were obtained in all patients during an average follow-up period of 20.4 mo. CT scans confirmed post-resection hypertrophy of the spared liver and lack of significant cyst progression. All patients had mild to severe ascites. Two patients were complicated with pleural effusion. CONCLUSION: Some highly symptomatic patients with massive PLD may benefit from combined hepatic resection and fenestration at acceptable risk. To stitch the dissected hepatic ligaments could prevent the instable remnant liver from kinking and collapsing.

Adult↗
PubMed1990

Ultrasound of the septum pellucidum. Recognition of evolving fenestrations in the hydrocephalic infant.

Fenestrations of the septum pellucidum may be noted in hydrocephalic infants. This finding and its changing image was noted in six premature infants evaluated by neurosonography over time periods ranging from weeks to months. Breaks in the septum were noted to occur from 14 days to 23 weeks after the sonographic diagnosis of hydrocephalus. Some of these fenestrations were noted to increase in size and/or become bilateral over time. The awareness of evolving fenestrations and their late-stage images helps avoid confusion with partial and complete agenesis of the septum pellucidum and their possible associated neuroanatomical abnormalities.

Cerebral Hemorrhage↗
PubMed1999

Multichannel fenestrations of the petrous segment of the internal carotid artery.

Multichannel fenestration of the internal carotid artery (ICA) is a rare, previously unreported developmental anomaly with unknown clinical significance. Although previously thought to have distinct embryologic origins, the presence of multiple channels in a short-segment fenestration favors a common developmental pathway for the origin of duplications and fenestrations: the persistence of a plexiform vascular network from the 4-mm to 5-mm embryologic stage of development.

Aged↗