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PubMedDate not supplied

Saccular aneurysms in basilar artery fenestration.

Of 59 cases of vertebrobasilar junction aneurysms diagnosed and treated from January 1977 to April 1986, 21 (35.5%) saccular aneurysms arose in a fenestration of the proximal basilar artery. Defects of the media at the junctures of the fenestrated segments, as well as the possible presence of turbulent flow at the vertebrobasilar junction, may explain the high incidence of vertebrobasilar aneurysms associated with proximal basilar artery fenestration.

Adult↗

PubMed1987

[A case of basilar artery fenestration with recurrent attacks of vertebrobasilar insufficiency].

Fenestration of basilar artery is an uncommon vascular anomaly that is usually an incidental product on autopsy or angiography. None of the cases in the literature had clinical symptoms associated with this anomaly except for subarachnoid hemorrhage when accompanied with saccular aneurysm. We report a rare case of the basilar artery fenestration associated with clinical symptoms without any aneurysm. A 71-years-old male, who had been treated for labile hypertension and had had recurrent attacks of vertigo, nausea, sometimes diplopia or unsteady gait, for 5 years, was referred to our hospital on Sept. 13, 1985. One day prior to admission, he suddenly felt diplopia and vertigo and unsteady gait. His family noticed he was dysarthric. On admission, he was alert and normotensive. He complained of dysesthesia on the right half of the perioral region and his right fingers. A neurological examination showed a mild weakness and hyperactive deep tendon reflexes on his right leg. His motor coordination was almost normal, but he was unsteady when he stood on one foot with his eyes closed. Laboratory examinations were normal except for an elevated serum uric acid level. A chest x-ray film showed a sclerotic change of aorta and mild cardiomegaly. Left ventricular hypertrophy was observed on his ECG. His CT scans showed multiple lacunae and mild brain atrophy. On cerebral angiography, his basilar artery (BA) had a fenestration almost in its total length that divided the BA, like a duplication, into two components with a smaller diameter than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1986

Myocutaneous fenestration in sleep apnea patients.

We present a patient with severe obstructive sleep apnea syndrome (OSAS), including O2 desaturations to 11%, who was successfully managed with myocutaneous fenestration tracheostomy. The myocutaneous fenestration technique employs bilateral horizontal skin-platysma advancement flaps sutured directly to a tracheal fenestra created between rings two to four. It conforms ideally to the unique physical and psychological demands of the sleep apnea patient. Rapid healing time and minimal granulation tissue, combined with a permanently functional, yet reversible and minimally disfigurative stoma, highlight the advantages of the technique over standard tracheostomy. The myocutaneous fenestration tracheostomy is uniquely applicable to the surgical treatment of patients with moderate to severe obstructive sleep apnea.

Humans↗

PubMedDate not supplied

[Extent of fenestration in one-level operations for lateral herniation of the intervertebral disk of the lumbar segment of the spine].

In the years 1969-1986 operations were carried out in 1650 cases of lateral prolapse of the lumbar nucleus pulposus at one level, they accounted for 75% of patients operated on for symptomatic sciatic pains. The operations were done in lateral recumbent position. In 29% of cases it was necessary to extend the typical fenestration by reducing the size of one or two halves of the vertebral arches, and in 12% of cases full hemilaminectomy was done. The most frequent cause of fenestration extension was narrow yellow ligament and massive broad vertebral arches at the level of the prolapsed nucleus, as well as congenital or acquired narrowing of the lateral recess of the vertebral canal. In only 4% of cases the necessity of fenestration extension was due to displacement of the free fragments of the prolapsed nucleus far from the intervertebral space or their falling into the meningeal sac.

Humans↗

PubMed1984

Comparison of fenestrations in internal elastic laminae of canine thoracic and abdominal aortas.

All non-elastin tissue was removed from canine aortas by placing them in 0.1 N NaOH at 75 degrees C for varying periods of time. The segments of aorta were weighed in a Mettler Chemical Balance at intervals. In 10 dogs the average weight of the thoracic aorta was 5.01 +/- 0.388 (SE) g while that of the abdominal aorta was 3.08 +/- 0.346 g. After digestion, the thoracic aorta weighed 3.34 +/- 0.0275 g and the abdominal aorta 0.85 +/- 0.085 g. Thus, the elastin makes up 67% of the thoracic aorta but only 28% of the abdominal aorta. These are equivalent to 0.334 g/kg body weight for the thoracic aorta and 0.224 g/kg body weight for the abdominal aorta. The values were always stable between 5 and 7 h and usually between 3 and 12 h. Aortic elastin was obtained from 5 dogs after 5-7 h of digestion and prepared for analysis by scanning electron microscopy. The dimensions of the fenestrations in the internal elastic laminae were quantified as described previously. The lower abdominal aorta had the largest holes (2.227 +/- 0.048 micron), and the upper thoracic aorta the smallest holes (0.954 +/- 0.032 micron). There was no significant difference in the size of the fenestrations along the thoracic aorta, but those in the lower abdominal aorta were larger than those in the upper abdominal aorta. The possible significance of the fenestrations in the genesis of aortic disease is discussed briefly.

Animals↗

PubMed1995

[A case of ruptured cerebral aneurysm associated with fenestrated vertebral artery in osteogenesis imperfecta].

An extremely rare case of ruptured cerebral aneurysm associated with a fenestrated vertebral artery in osteogenesis imperfecta (OI) is presented. A 33-year-old female suffering from OI was admitted to our hospital with severe headache and vomiting. A CT scan revealed subarachnoid hemorrhage. Cerebral angiography with four vessel study showed a fenestration in the V3 portion of the left vertebral artery and a dilatation in its V4 portion, but no cerebral aneurysm was detected. After conservative treatment for three weeks, repeated angiography demonstrated an aneurysm of the anterior communicating artery. A neck clipping of the aneurysm was performed successfully. The patient was discharged with no neurological deficits. OI is a hereditary connective tissue disease characterized by bone fragility. From her family history and clinical findings, the patient was suspected to have OI type I of Sillence's classification. Among the connective tissue diseases, OI does not have complications in the cerebrovascular system as frequently as other connective tissue diseases do, for example, Marfan's syndrome, Ehlers-Danlos syndrome, or pseudoxanthoma elasticum. Carotid-cavernous fistula and moyamoya disease have been the only complications reported in OI. However, dilatation of the aortic root and increased vascular fragility have been reported recently in OI. Although this is the first reported case of a ruptured aneurysm accompanied by a fenestration and a dilatation of the vertebral artery associated with OI, it was suggested that vascular fragility caused by collagen abnormality might affect the cerebral vasculature.

Adult↗

PubMed1993

[A new device: a fenestrated sheath for IABP, which reduces the incidence of ischemia in the lower limbs].

To decrease the incidence of ischemia in the lower limbs, we developed a new introducer sheath for IABP, which had 38 side holes (diameter; 1mm). Forty-five patients who received IABP counterpulsation support with this fenestrated sheath were compared with 108 patients in whom the ordinary nonfenestrated sheath was used. There was no significant statistical difference between these two study groups regarding age, height, weight and IABP insertion time. The frequency of ischemic episode of the lower limbs was 2.2% (one out of 45 patients) in the group with the fenestrated sheath, which was significantly lower than those with the ordinary sheath (18 out of 108: 16.7%) (p < 0.005). From these data, we deduced that this fenestrated sheath allowed more blood flow to the lower limb and was thus effective in preventing limb ischemia, particularly in patients with small caliber femoral arteries.

Aged↗

PubMed1995

[A case of tricuspid atresia treated with fenestrated total cavopulmonary connection at late infantile stage].

A one-year-old girl with tricuspid atresia (TA) underwent fenestrated totalcavopulmonary connection (TCPC) after pulmonary artery banding. Under cardiopulmonary bypass, an fenestrated intraatrial cavocaval channel was constructed with a prosthetic graft of polytrafluorothylene. The SVC was transsected and each end of SVC was anastomosed to the pulmonary artery in a end-to-side fashion. She did not need "high CVP management" nor "low HR management" in the post operative course. We suggest that fenestrated TCPC may be indicated for the patients of TA at late infantile stage.

Blood Vessel Prosthesis↗

PubMedDate not supplied

Treatment of dehiscences and fenestrations around dental implants using resorbable and nonresorbable membranes associated with bone autografts: a comparative clinical study.

This study was carried out to evaluate the efficacy of poly(lactic acid) and poly(glycolic acid) (PLA/PGA) resorbable membranes in conjunction with autogenous bone grafts when used for the treatment of implant dehiscences and/or fenestrations. Nine patients with a total of 18 implants participated. Nine implants were associated with dehiscences, and 9 with fenestrations; 16 implants were in the maxilla, and 2 in the mandible. Nine defects were treated with PLA/PGA membranes (test group), and the nine were treated with expanded polytetrafluoroethylene (e-PTFE) membranes (control group). Second-stage surgery was performed after 6 to 7 months of healing. Overall results of the regenerative therapy of the 18 defects showed a highly significant (P < .001) defect reduction, with a 93.38% (SD = 15.88) bone fill. A slightly higher percentage of bone fill was found in the e-PTFE group (98.20%) than in the PLA/PGA group (88.56%), but the difference was not statistically significant (P = .207). This study demonstrated that resorbable PLA/PGA membranes can be equally effective as e-PTFE in the treatment of implant dehiscences and fenestrations when associated with autogenous bone chips.

Adult↗

PubMed1997

[Laparoscopic fenestration in the management of symptomatic polycystic liver disease].

We report the case of a 70-year-old woman with polycystic disease of the liver and kidney, complicated with rupture and hemorrhage of the hepatic cysts located in the right lobe. A laparoscopic approach was used. After identifying the polycystic mass, the cytologic examination of the aspirated hematic fluid and the intraoperative biopsy showed its benign nature. An hepatic fenestration was performed. Hemostasis was achieved by electrosurgical and argon probes. The postoperative course was satisfactory and radiological improvement was demonstrated on the CT scan 3 months later. Follow-up examination one year later has been uneventful. Fenestration is one of the less stressing surgical options in the adult polycystic liver disease when treatment is indicated. The laparoscopic approach may be used with safety to perform a similar technique in selected cases, establishing a communication between the cysts and the peritoneal cavity. Nevertheless, it may be difficult to reach deeply situated cysts and to differentiate them from vascular structures. Laparoscopic intraoperative ultrasonography might be of great value in these cases. Likewise, long term studies are needed to determine the benefits and the indications of the laparoscopic fenestration.

Aged↗

PubMed1997

Laparoscopic fenestration for giant liver cyst.

Laparoscopic fenestration for treatment of the non-parasitic cyst of the liver has been rarely reported, but sporadic cases appeared elsewhere in the literature. Here we report four cases with symptomatic giant nonparasitic liver cysts which were treated by a laparoscopic fenestration procedure that allowed the successful removal of the cyst dome. Before starting to excise the wall of the cyst, laparoscopic-quided needle aspiration of the cyst fluid was done first in order to clean the visual field for laparoscopic intervention where possible. The cyst wall was usually slightly transparent and somewhat smooth in the external and internal surface of the cysts. It was necessary to lysis the omental adhesion sometime before starting to remove the dome of the cyst. The cyst wall of the exposed part could be removed first with heat-probe instrument through laparoscopy. Those patients were discharged and revealed an uneventful post-operative course in three cases but in one case we had to convert to the traditional laparostomy to perform resection of the multiple cystic lesions. Post-operative echographic study showed that the giant cyst had collapsed. Therefore, we believe laparoscopic fenestration for the liver cyst is simple and effective, if the patient is a candidate who requires operation to remove the dome of the giant cyst.

Adult↗

PubMed1998

[Fenestration of diaphragm for management of persistent postoperative pleural effusion: clinical experience and experiment in rabbits].

UNLABELLED: The management of persistent postoperative pleural effusion is still considered difficult. We report here our experience with such a case, successfully managed with fenestration of the diaphragm-the first of it's kind. Clinical Experience: A two-year-old boy with double outlet right ventricle, underwent right heart bypass procedure. Due to low output and high venous pressure, he was on ventilator until the 26th postoperative day. The pericardial and right pleural effusion persisted till the 60th postoperative day. Right phrenic nerve palsy and atelectasis of right lower lobe were suspected to contribute to it. We performed a plication of the right diaphragm and fenestration of the pericardium and right diaphragm. A T-shaped incision was made on the right diaphragm and the edges were trimmed and strengthened with non-absorbable suture into a circular shaped defect of 1.5 cm diameter. The defect was closed with a Dacron mesh allowing passage of fluid across. Pleural effusion decreased immediately and he was discharged a month after the procedure. Experimental Study: The above procedure was experimented in rabbits in whom a contrast medium injected into the pleural cavity could easily drain into the peritoneum through the fenestation, proved by fluoroscopy. CONCLUSION: Fenestration of the diaphragm is an effective procedure to manage persistent pleural effusion.

Animals↗

PubMed1998

Massive aortic regurgitation by spontaneous rupture of a fibrous strand in a fenestrated aortic valve.

A very rare case of Marfan syndrome associated with acute aortic regurgitation due to rupture of a fibrous strand of a fenestrated aortic valve is presented. Although an aortic valve fenestration usually has no pathologic significance, its association with aortic annular dilatation plays an important role. Rupture of a myxomatously degenerated fibrous strand loaded with high tension from annular dilatation reducing the coaptation area of each cusp during diastole was the suspected cause of acute massive regurgitation by complete retroversion of the right coronary cusp. Rupture of a fibrous strand of a fenestrated aortic valve with a dilated annulus could result in acute massive aortic regurgitation, for which prompt surgical repair is mandatory.

Adult↗

PubMed1975

A method of stapedectomy in the fenestrated ear.

Two consequences of a previous fenestration militate against successful stapledectomy. They are the lessened depth of the middle ear over the stapes, and the missing incus. Twelve years' experience of using the stapedectomy for fenestrated ears in 62 patients has given generally disappointing results until, in 1962, technique of using cartilage blocks to increase the depth of the middle ear was devised.

Adult↗

PubMed1985

Fenestration: a twenty-five-year evaluation.

A review was made at least 25 years after surgery on a series of patients who had been fenestrated for otosclerosis. Adequate follow-up information was obtained on 28 of the original 58 subjects. Of these three still had hearing above the social adequacy level of 30 db. HL. One half of the subjects had hearing that was still significantly better than it had been prior to surgery. Twenty-five years post-operatively more than half the patients were using hearing aids, generally with a high degree of satisfaction. Four out of five patients indicated that with hindsight they would still have gone ahead and had the operation. The small residual conductive impairment in a fenestrated ear appears to act as a protection against the effects of acoustic insult, in that the rate of decline of hearing with age in male subjects is less than the average for a normal population of adult males. The rate of decline approximates more closely with the assumed non-noise exposed female population.

Adult↗

PubMed2002

The fenestration operation of Lempert: a historical perspective.

OBJECTIVE: To describe the events surrounding the introduction of the one-stage fenestration operation for otosclerosis and the presentation of the paper given to the American Otological Society in 1938. DATA SOURCES: Published data in scientific journals and news media, archival material from the New York Academy of Medicine and the John Q. Adams Center of The American Academy of Otolaryngology-Head and Neck Surgery, and a personal interview with the late Gordon D. Hoople, M.D. CONCLUSION: This article describes Dr. Gordon Hoople's exclusive account of the events surrounding the presentation of the first paper of the Lempert one-stage fenestration operation to the American Otological Society, why it was never published, why detailed proceedings of The Society were expunged from the record, and why Samuel J. Kopetzky was expelled from the American Otological Society.

Fenestration, Labyrinth↗

PubMed1984

Fenestral otosclerosis: significance of preoperative CT evaluation.

Thirty-five consecutive patients with the clinical diagnosis of fenestral otosclerosis were evaluated with high-resolution computed tomography (CT). Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescences at or adjacent to the oval window. The diagnosis was made upon examination of 1.5-mm-thick targeted sections obtained at 0.5-mm intervals in the axial projection. Coronal sections were also included. Sections were also evaluated for evidence of plaque formation elsewhere in the lateral wall of the labyrinth and for surgical obstacles such as an abnormally wide cochlear aqueduct, a high jugular vein, and a dehiscent facial nerve. It is concluded that fenestral otosclerosis may be accurately diagnosed with proper CT techniques.

Adult↗

PubMed1994

Fenestration of the middle cerebral artery associated with an aneurysm--case report.

A 36-year-old female suddenly developed a severe headache. Computed tomography demonstrated subarachnoid hemorrhage in the left Sylvian fissure. Left carotid angiography revealed a fenestration at the distal portion of the M1 portion of the left middle cerebral artery, and an aneurysm arising from the proximal end of the fenestration. These findings were confirmed when the aneurysm neck was clipped. The embryonic origin of this lesion indicates that congenital factors may result in aneurysm formation.

Adult↗