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Cooke, Daniel L., Charles E. Stout, Warren T. Kim, Akash P. Kansagra, John Paul Yu, Amy Gu, Nicholas P. Jewell i in. "Cerebral Arterial Fenestrations". Interventional Neuroradiology 20, nr 3 (1.01.2014): 261–74. http://dx.doi.org/10.15274/inr-2014-10027.
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Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms “fenestration” or “fenestrated” with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms.
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Gambarini, Gianluca, Gabriele Miccoli, Gianfranco Gaimari, Deborah Pompei, Andrea Pilloni, Lucila Piasecki, Dina Al-Sudani, Dario Di Nardo i Luca Testarelli. "Detection of Bone Defects Using CBCT Exam in an Italian Population". International Journal of Dentistry 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/7523848.
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Background. The aim of this study was to evaluate the in vivo incidence and the location of fenestrations in a young Italian population by using CBCT. Materials and Methods. Fifty patients who had previously performed CBCT for planning third molar extraction or orthodontic therapy were selected for the study. No previous dental treatment had been performed on these patients. Overall, 1,395 teeth were evaluated. Root fenestrations were identified according to the definition of Davies and the American Association of Endodontists. Data was collected and statistically analyzed. Results. Fenestrations were observed in 159 teeth out of 1,395 (11% of teeth). In the lower jaw, we found 68 fenestrations (5%) and 91 in the maxilla (6,5%). Incisors were the teeth with the highest incidence of fenestrations. Conclusion. The relative common finding (11%) of fenestration supports the need for CBCT exams before any surgical/implant treatment to avoid complications related to the initial presence of fenestrations. CBCT was found to be an effective and convenient tool for diagnosing fenestration.
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Zapotoczny, Bartlomiej, Karolina Szafranska, Malgorzata Lekka, Balpreet Singh Ahluwalia i Peter McCourt. "Tuning of Liver Sieve: The Interplay between Actin and Myosin Regulatory Light Chain Regulates Fenestration Size and Number in Murine Liver Sinusoidal Endothelial Cells". International Journal of Molecular Sciences 23, nr 17 (30.08.2022): 9850. http://dx.doi.org/10.3390/ijms23179850.
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Liver sinusoidal endothelial cells (LSECs) facilitate the efficient transport of macromolecules and solutes between the blood and hepatocytes. The efficiency of this transport is realized via transcellular nanopores, called fenestrations. The mean fenestration size is 140 ± 20 nm, with the range from 50 nm to 350 nm being mostly below the limits of diffraction of visible light. The cellular mechanisms controlling fenestrations are still poorly understood. In this study, we tested a hypothesis that both Rho kinase (ROCK) and myosin light chain (MLC) kinase (MLCK)-dependent phosphorylation of MLC regulates fenestrations. We verified the hypothesis using a combination of several molecular inhibitors and by applying two high-resolution microscopy modalities: structured illumination microscopy (SIM) and scanning electron microscopy (SEM). We demonstrated precise, dose-dependent, and reversible regulation of the mean fenestration diameter within a wide range from 120 nm to 220 nm and the fine-tuning of the porosity in a range from ~0% up to 12% using the ROCK pathway. Moreover, our findings indicate that MLCK is involved in the formation of new fenestrations—after inhibiting MLCK, closed fenestrations cannot be reopened with other agents. We, therefore, conclude that the Rho-ROCK pathway is responsible for the control of the fenestration diameter, while the inhibition of MLCK prevents the formation of new fenestrations.
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Czyżewski, Wojciech, Zofia Hoffman, Michał Szymoniuk, Patrycja Korulczyk, Kamil Torres i Grzegorz Staśkiewicz. "The Incidence, Localization and Clinical Relevance of Arterial Fenestrations and Their Association to Brain Aneurysms: A Case–Control Study Based on the STROBE Guidelines". Brain Sciences 12, nr 10 (28.09.2022): 1310. http://dx.doi.org/10.3390/brainsci12101310.
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Background: Fenestrations are rare, but well-known, vascular variations of the cerebral arteries. They are mostly incidental, asymptomatic angiographic findings and might precipitate vascular lesions such as AVM, aneurysmal dilatation, or even ischemic symptoms. However, association between arterial fenestration and brain aneurysms has not been clearly established. Objective: To evaluate whether incidence of arterial fenestrations are associated with brain aneurysm development and investigate the prevalence and most-common localizations of arterial fenestrations of the human brain. Design: Case–control study. Setting: All patients examined by CT angiography in University Hospital No. 4 in Lublin from 2009 to 2019. Patients: Each patient showing at least one cerebral aneurysm was included in the case group and each patient without cerebral aneurysm on CT angiography was included in the control group. Measurements: CT angiography examinations were conducted using the standard protocol used in the 1st Department of Radiology, Medical University of Lublin, Poland. The database and statistical research were conducted by use of the Statistica software (ver. 13.3, Tibco Software Inc., Palo Alto, CA, USA). Results: A total of 6545 CTA examinations were included in the study. Most of the aneurysms were located on the MCA: 629 (38.59%), ICA: 466 (28.59%) and AComA: 192 (11.78%). Cerebral arterial fenestration showed a non-statistically significant elevated risk for brain aneurysms in the entire study population (OR: 1.157; 95% CI: 0.826–1.621; p = 0.39). Among 6545 cranial CTA examinations, cerebral vessel fenestration was found in 49 of them, which constituted 0.75%. The most common vascular fenestrations were those located in the ACA (30.61%), BA (30.61%) and AComA (22.45%), while other fenestrations occurred infrequently. There were no significant differences in the age of patients in the individuals with vascular fenestration (p > 0.05). VA fenestration was slightly more common in men (16.67%) than in women (5.41%). However, these differences were not statistically significant (p = 0.216). Limitations: Our study has several limitations, including selection bias regarding examined population. Second, we assume that the total number of fenestrations detected in our study was underestimated due to the limitations of the CT method in comparison to other radiologic modalities. Conclusions: Cerebral arterial fenestrations are rare vascular malformations. The ACA is the most common localization of fenestrations, followed by BA and AComA. Fenestrations of cerebral arteries insignificantly increase the risk of cerebral aneurysm formation. Further prospective studies are necessary to make this association more precise.
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Hunt, Nicholas J., Glen P. Lockwood, Alessandra Warren, Hong Mao, Peter A. G. McCourt, David G. Le Couteur i Victoria C. Cogger. "Manipulating fenestrations in young and old liver sinusoidal endothelial cells". American Journal of Physiology-Gastrointestinal and Liver Physiology 316, nr 1 (1.01.2019): G144—G154. http://dx.doi.org/10.1152/ajpgi.00179.2018.
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Fenestrations are pores within liver sinusoidal endothelial cells (LSECs) that enable the transfer of substrates (particularly insulin and lipoproteins) between blood and hepatocytes. With increasing age, there are marked reductions in fenestrations, referred to as pseudocapillarization. Currently, fenestrations are thought to be regulated by vascular endothelial growth factor and nitric oxide (NO) pathways promoting remodeling of the actin cytoskeleton and cell membrane lipid rafts. We investigated the effects of drugs that act on these pathways on fenestrations in old (18–24 mo) and young mice (3–4 mo). Isolated LSECs were incubated with either cytochalasin 7-ketocholesterol, sildenafil, amlodipine, simvastatin, 2, 5-dimethoxy-4-iodoamphetamine (DOI), bosentan, TNF-related apoptosis-inducing ligand (TRAIL) or nicotinamide mononucleotide (NMN). LSECs were visualized under scanning electron microscopy to quantify fenestration porosity, diameter, and frequency, as well as direct stochastic optical reconstruction microscopy to examine actin and NO synthase. In young and old LSECs, fenestration porosity, diameter and frequency were increased by 7-ketocholesterol, while porosity and/or frequency were increased with NMN, sildenafil, amlodipine, TRAIL, and cytochalasin D. In old mice only, bosentan and DOI increased fenestration porosity and/or frequency. Modification of the actin cytoskeleton was observed with all agents that increased fenestrations, while NO synthase was only increased by sildenafil, amlodipine, and TRAIL. In conclusion, agents that target NO, actin, or lipid rafts promote changes in fenestrations in mice LSECs. Regulation of fenestrations occurs via both NO-dependent and independent pathways. This work indicates that age-related defenestration can be reversed pharmacologically, which has potential translational relevance for dyslipidemia and insulin resistance. NEW & NOTEWORTHY We demonstrate the effects of multiple nitric oxide-dependent and -independent pharmaceutical agents on fenestrations of the liver sinusoidal endothelium. Fenestrations are reorganized in response to nicotinamide mononucleotide, sildenafil, amlodipine, and TNF-related apoptosis-inducing ligand. This work indicates that age-related defenestration can be reversed pharmacologically, which has potential translational relevance for dyslipidemia and insulin resistance in old age.
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Sogawa, Keiji, Yoichi Kikuchi, Toshihiro O'Uchi, Michihiro Tanaka i Tomio Inoue. "Fenestrations of the Basilar Artery Demonstrated on Magnetic Resonance Angiograms: An Analysis of 212 Cases". Interventional Neuroradiology 19, nr 4 (grudzień 2013): 461–65. http://dx.doi.org/10.1177/159101991301900409.
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Fenestration of the basilar artery (BA) is a rare variant of the intracranial artery, well demonstrated in autopsy and angiographic studies. Some angiographic series show a high incidence of associated aneurysms at the basilar fenestration site. The purpose of this study is to report the incidence of BA fenestration, its configurations, associated aneurysms, and arterial anomalies in a large series of intracranial MR angiograms (MRAs). A total of 16,416 MRAs were retrospectively reviewed to identify the location, size and associated intracranial arterial anomalies of BA fenestrations. All images were obtained with the time-of-flight (TOF) technique. Of the 16,416 MRAs, 215 fenestrations were found in 212 cases (1.29%). Most fenestrations were located in the proximal BA. The average length of the fenestration was 4.6 mm; the largest was 15.6 mm. No aneurysm was found at the site of the fenestration. Thirteen aneurysms were found in nine cases at locations other than the BA: seven in the middle cerebral artery (MCA), one in the anterior cerebral artery (ACA), one in the anterior communicating artery (Acom), one in the vertebral artery (VA), one at the carotid siphon, and two at the internal carotid-posterior communicating artery (IC-PC). Arterial anomalies in other locations were found in 26 cases. BA fenestrations were found in 1.29% of the 16,416 cases studied. There were no aneurysms at the BA fenestration site. Aneurysms at the BA fenestration site may be an exceedingly rare phenomenon.
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Lin, Jing, Niraj Parikh, Naval Udgiri, Shaoxia Wang, Daniel F. Miller, Chaojing Li, Jean Panneton i in. "Laser Fenestration of Aortic Stent-Grafts Followed by Noncompliant vs Cutting Balloon Dilation: A Scanning Electron Microscopy Study". Journal of Endovascular Therapy 25, nr 3 (25.04.2018): 397–407. http://dx.doi.org/10.1177/1526602818772311.
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Purpose: To examine the effects of in situ laser fenestration and subsequent balloon dilation (noncompliant vs cutting) on the graft fabric of 4 aortic stent-graft models. Method: In an in vitro setup, the Zenith TX2, Talent, Endurant, and Anaconda aortic stent-grafts (all made of polyester graft material) were subjected to laser fenestration with a 2.3-mm-diameter probe at low and high energy in a physiologic saline solution followed by balloon dilation of the hole. For the first series of tests, 6-mm-diameter noncompliant balloons were used and replaced for the second series by 6-mm-diameter cutting balloons. Each procedure was performed 5 times (5 fenestrations per balloon type). The fenestrations were examined visually and with light and scanning electron microscopy. Results: Each fenestration demonstrated various degrees of fraying and/or tearing regardless of the device. The monofilament twill weave of the Talent endograft tore in the warp direction up to 7.09±0.46 mm at high energy compared with 2.41±0.26 mm for the Endurant multifilament device. The fenestrations of the 3 endografts with multifilament weave (Zenith, Anaconda, and Endurant) showed more fraying; fenestration areas in the multifilament Endurant were >10 mm2 at low and high energy. The fenestrations were free of melted fibers, but minor blackening of the filaments was observed in all devices. Overall, the cutting balloons resulted in worse tearing and damage. Of note, the edges of the dilated laser-formed fenestrations of the Talent and the Endurant grafts demonstrated evidence of additional shredded yarns. Conclusion: In situ fenestration does not cause any melting of the polyester; however, the observed structural damage to the fabric construction must be carefully considered. Cutting balloons caused various levels of tearing compared to the noncompliant balloons and cannot be recommended for use in this application. Rather, noncompliant balloons should be employed, but only with endografts constructed from multifilament yarns. The use of in situ fenestration must be restricted to urgent and emergent cases until long-term durability can be determined.
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Cogger, Victoria Carroll, Mashani Mohamad, Samantha Marie Solon-Biet, Alistair M. Senior, Alessandra Warren, Jennifer Nicole O'Reilly, Bui Thanh Tung i in. "Dietary macronutrients and the aging liver sinusoidal endothelial cell". American Journal of Physiology-Heart and Circulatory Physiology 310, nr 9 (1.05.2016): H1064—H1070. http://dx.doi.org/10.1152/ajpheart.00949.2015.
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Fenestrations are pores within the liver sinusoidal endothelial cells (LSECs) that line the sinusoids of the highly vascularized liver. Fenestrations facilitate the transfer of substrates between blood and hepatocytes. With pseudocapillarization of the hepatic sinusoid in old age, there is a loss of fenestrations. LSECs are uniquely exposed to gut-derived dietary and microbial substrates delivered by the portal circulation to the liver. Here we studied the effect of 25 diets varying in content of macronutrients and energy on LSEC fenestrations using the Geometric Framework method in a large cohort of mice aged 15 mo. Macronutrient distribution rather than total food or energy intake was associated with changes in fenestrations. Porosity and frequency were inversely associated with dietary fat intake, while fenestration diameter was inversely associated with protein or carbohydrate intake. Fenestrations were also linked to diet-induced changes in gut microbiome, with increased fenestrations associated with higher abundance of Firmicutes and reduced abundance of Bacteroidetes. Diet-induced changes in levels of several fatty acids (C16:0, C19:0, and C20:4) were also significantly inversely associated with fenestrations, suggesting a link between dietary fat and modulation of lipid rafts in the LSECs. Diet influences fenestrations and these data reflect both the key role of the LSECs in clearing gut-derived molecules from the vascular circulation and the impact these molecules have on LSEC morphology.
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Dima, Stefanita, i Mugurel Radoi. "Basilar artery fenestration associated with aneurysms treated by endovascular approach". Romanian Neurosurgery 19, nr 4 (1.12.2012): 273–79. http://dx.doi.org/10.2478/v10282-012-0015-0.
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Abstract Introduction: Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat with open surgical techniques. Basilar artery fenestration reported in the literature is highly variable depending on the technique used. Typically fenestration occurs at the lower end of the basilar artery just at the vertebral arteries join. For basilar artery fenestrations associated with aneurysms endovascular embolization could be the first treatment choice. Methods: This study presented three cases of patients having basilar artery fenestration associated with aneurysm that were treated endovascularly. All patients underwent endovascular embolization by femoral approach, under general anesthesia. Results: In all three cases, no new neurological deficits were reported. Balloon remodeling technique was necessary in one patient that presented kissing aneurysms. The length of the follow-up was 3 years for 2 patients, and 1 year for one patient. All the aneurysms, except one, presented a small recanalization at four vessels digital subtraction angiography (DSA) control, but it remained stable even at the three years control. Conclusions: Endovascular treatment of basilar artery aneurysms associated with fenestrations is a safe and durable option. No second embolization procedure was necessary in our cases. No limb of the fenestration was necessary to be sacrificed. Larger series of patients treated with this method are needed to support our evidence.
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Dunmore, P. Joy, S. H. Song i Margot R. Roach. "A comparison of the size of fenestrations in the internal elastic lamina of young and old porcine aortas as seen with the scanning electron microscope". Canadian Journal of Physiology and Pharmacology 68, nr 2 (1.02.1990): 139–43. http://dx.doi.org/10.1139/y90-022.
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The size of the fenestrations (windows) in the internal elastic lamina (IEL) of arteries may be important in the functioning of the blood vessel wall. The fenestrations are filled with collagen, muscle, and (or) ground substance, which must be removed to make the fenestration visible with the scanning electron microscope. All of the nonelastic components are removed with a hot alkali solution. Our experiments were designed to compare the fenestration size in the IEL of the thoracic aorta of young (6–8 weeks) and old (6–9 months) pigs. A protocol for digestion of young pig tissue was developed and showed that fresh young aortas should be digested in 0.1 M NaOH at 75 °C for 2 h and fixed tissue should be digested for 5 h. The average area of the fenestrations for young pig thoracic aortas digested for 2 h was 1.8 ± 0.29 (SE) μm2 and for the old pig aortas digested for 2 h was 1.7 ± 0.11 (SE) μm2. These values were not significantly different (p > 0.05), but the IEL from young pigs appeared rougher than the previously reported smooth IEL of the adult pigs.Key words: elastin, fixation, digestion, fenestration, scanning electron microscope.
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Bustos, Daniel, Mauricio Bedoya, David Ramírez, Guierdy Concha, Leandro Zúñiga, Niels Decher, Erix W. Hernández-Rodríguez, Francisco V. Sepúlveda, Leandro Martínez i Wendy González. "Elucidating the Structural Basis of the Intracellular pH Sensing Mechanism of TASK-2 K2P Channels". International Journal of Molecular Sciences 21, nr 2 (14.01.2020): 532. http://dx.doi.org/10.3390/ijms21020532.
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Two-pore domain potassium (K2P) channels maintain the cell’s background conductance by stabilizing the resting membrane potential. They assemble as dimers possessing four transmembrane helices in each subunit. K2P channels were crystallized in “up” and “down” states. The movements of the pore-lining transmembrane TM4 helix produce the aperture or closure of side fenestrations that connect the lipid membrane with the central cavity. When the TM4 helix is in the up-state, the fenestrations are closed, while they are open in the down-state. It is thought that the fenestration states are related to the activity of K2P channels and the opening of the channels preferentially occurs from the up-state. TASK-2, a member of the TALK subfamily of K2P channels, is opened by intracellular alkalization leading the deprotonation of the K245 residue at the end of the TM4 helix. This charge neutralization of K245 could be sensitive or coupled to the fenestration state. Here, we describe the relationship between the states of the intramembrane fenestrations and K245 residue in TASK-2 channel. By using molecular modeling and simulations, we show that the protonated state of K245 (K245+) favors the open fenestration state and, symmetrically, that the open fenestration state favors the protonated state of the lysine residue. We show that the channel can be completely blocked by Prozac, which is known to induce fenestration opening in TREK-2. K245 protonation and fenestration aperture have an additive effect on the conductance of the channel. The opening of the fenestrations with K245+ increases the entrance of lipids into the selectivity filter, blocking the channel. At the same time, the protonation of K245 introduces electrostatic potential energy barriers to ion entrance. We computed the free energy profiles of ion penetration into the channel in different fenestration and K245 protonation states, to show that the effects of the two transformations are summed up, leading to maximum channel blocking. Estimated rates of ion transport are in qualitative agreement with experimental results and support the hypothesis that the most important barrier for ion transport under K245+ and open fenestration conditions is the entrance of the ions into the channel.
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Tanaka, M., Y. Kikuchi i T. Ouchi. "Neuroradiological Analysis of 23 Cases of Basilar Artery Fenestration Based on 2280 Cases of MR Angiographies". Interventional Neuroradiology 12, nr 1_suppl (styczeń 2006): 39–44. http://dx.doi.org/10.1177/15910199060120s103.
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Basilar artery (BA) fenestrations are the most frequently observed variant of the cerebral arteries. We examined the magnetic resonance (MR) angiographic incidence, location, characteristic configuration of BA fenestration and associated vascular disease. From April 2004 to September 2004, a total of 2280 cranial MR angiographies were performed at our institution. Twenty-three BA fenestrations (1.0%) were detected on MRA. There were 13 males and ten females in this group and mean age was 57.6 years old. Three cases of these fenestration group are suffered with atherothrombic infarction in the territory of vertebro-basilar system. Seven of 23 cases (30%) were associated with intracranial aneurysm. Of those four cases, aneurysms were located at anterior circulation. Of those three cases, the aneurysms were associated with BA fenestration. Since saccular aneurysms are reported to arise frequently at BA fenestration, knowledge and recognition of fenestration are useful and important in the interpretation of cerebral MR angiography.
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Lufrano, Reuben, Matt Nies, Beau Ebben, Scott Hetzel, Robert V. O’Toole i Christopher J. Doro. "Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot". Foot & Ankle International 40, nr 7 (1.04.2019): 853–58. http://dx.doi.org/10.1177/1071100719839944.
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Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.
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Taher, Fadi, Juergen Falkensammer, Joseph Nguyen, Miriam Uhlmann, Edda Skrinjar i Afshin Assadian. "Assessing the institutional learning curve for pararenal aortic repair using the fenestrated Anaconda endograft". Vascular 27, nr 1 (11.09.2018): 46–50. http://dx.doi.org/10.1177/1708538118799132.
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Objective Custom-made fenestrated aortic endografts allow exclusion of pararenal aortic aneurysms while maintaining blood flow to aortic branches. Meticulous device planning and precise deployment of the main body are essential to allow successful cannulation of the fenestrations. This study investigates whether a learning curve can be observed with more reliable cannulation and connection of fenestrations over time at a single department of vascular and endovascular surgery with multiple surgeons trained to use the device. Methods A retrospective analysis of data from all patients undergoing primary fenestrated endovascular aneurysm repair during the study period was performed. Outcome measures included case volume and average number of fenestrations over time, average fluoroscopy dose area product per calendar year and primary unconnected fenestration and 30-day mortality rates. Results Between 1 January 2013 and 31 December 2016, 89 patients with no history of endovascular aneurysm repair underwent fenestrated endovascular aneurysm repair at our institution. The number of fenestrations per case increased over time, averaging 2.6 in 2013 and 3.3 in 2016. Primary unconnected fenestration and 30-day mortality rates were 5.6%. Primary-assisted technical success was 93.3%, secondary-assisted technical success was 94.4%. Fluoroscopy dose area product declined over the study period. Thirty-day mortality and primary unconnected fenestration rates did not significantly change over the study period. Conclusion Albeit the reduction in lethal complications and primary technical success rates were not statistically significant, a lower percentage of unconnected fenestrations and 30-day mortality per calendar year were observed over time. At the same time, an increasing complexity of performed cases, as reflected by an increasing number of fenestrations per case, was observed. Complications associated with this complex endovascular procedure are potentially lethal and remain an unfortunate reality and may not be entirely dependent on overcoming a learning curve. A higher volume of cases performed over the study period and a reduction in fluoroscopy use can be considered a representation of the institutional development and learning curve for the Anaconda fenestrated endograft at a department with prior complex endovascular aortic repair experience, but due to limitations of the current retrospective observation, deserve further consideration in future trials, ideally designed in a prospective fashion.
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Gamal El-Din, Tamer M., Michael J. Lenaeus, Ning Zheng i William A. Catterall. "Fenestrations control resting-state block of a voltage-gated sodium channel". Proceedings of the National Academy of Sciences 115, nr 51 (5.12.2018): 13111–16. http://dx.doi.org/10.1073/pnas.1814928115.
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Potency of drug action is usually determined by binding to a specific receptor site on target proteins. In contrast to this conventional paradigm, we show here that potency of local anesthetics (LAs) and antiarrhythmic drugs (AADs) that block sodium channels is controlled by fenestrations that allow drug access to the receptor site directly from the membrane phase. Voltage-gated sodium channels initiate action potentials in nerve and cardiac muscle, where their hyperactivity causes pain and cardiac arrhythmia, respectively. LAs and AADs selectively block sodium channels in rapidly firing nerve and muscle cells to relieve these conditions. The structure of the ancestral bacterial sodium channel NaVAb, which is also blocked by LAs and AADs, revealed fenestrations connecting the lipid phase of the membrane to the central cavity of the pore. We cocrystallized lidocaine and flecainide with NavAb, which revealed strong drug-dependent electron density in the central cavity of the pore. Mutation of the contact residue T206 greatly reduced drug potency, confirming this site as the receptor for LAs and AADs. Strikingly, mutations of the fenestration cap residue F203 changed fenestration size and had graded effects on resting-state block by flecainide, lidocaine, and benzocaine, the potencies of which were altered from 51- to 2.6-fold in order of their molecular size. These results show that conserved fenestrations in the pores of sodium channels are crucial pharmacologically and determine the level of resting-state block by widely used drugs. Fine-tuning drug access through fenestrations provides an unexpected avenue for structure-based design of ion-channel–blocking drugs.
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Nadarajah, Jeyaseelan, Nishchint Jain, Leve Joseph Devarajan Sebastian, SB Gaikwad, Ajay Garg i Anuj Prabhakar. "Endovascular management of a ruptured aneurysm associated with distal PICA fenestration". Interventional Neuroradiology 25, nr 4 (28.03.2019): 430–33. http://dx.doi.org/10.1177/1591019919838194.
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Fenestrations are rare but well-known arterial anatomic variations in which a segment of artery divides into two parallel channels that reunite distally. Although fenestrations as such are asymptomatic, they have gained clinical significance because of their association with aneurysms and other intracranial vascular pathologies. Here we present a 35-year-old woman with history of sudden severe occipital headache and vomiting. Imaging revealed a ruptured aneurysm in the distal posterior inferior cerebellar artery arising from one of the limbs of the fenestration. The aneurysm was successfully managed by coiling, and the patient made complete recovery without neurological sequelae.
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Rodrigues, Ewaldo Antônio Vieira, Walter Augusto Soares Machado, Casimiro Abreu Possante de Almeida, Andréia Cristina Breda de Souza Souza, Cláudia Callegaro de Menezes, Marcos De Oliveira Barceleiro, Walmir Júnio de Pinho Reis Rodrigues, Mario Taba Jr i Sérgio Kahn. "Prevalence of dehiscences and fenestrations in human cadavers." Revistas 74, nr 3 (25.09.2017): 198. http://dx.doi.org/10.18363/rbo.v74n3.p.198.
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Objective: the aim of the present study was to evaluate the prevalence of dehiscences and fenestrations in a convenience sample of human cadavers to provide accurate identification of bone defects. Material and Methods: twenty human cadavers, ranging in age from 20 to 40 years, were evaluated for dehiscences and fenestrations, which were verified after mucoperiosteal flap elevation. Results: the prevalence of dehiscences and fenestrations in the specimens was confirmed as being 40%, accounting for 5% of teeth with lesions. The most prevalent lesions were dehiscences, while only one single case of maxillary fenestration was observed. Conclusion: the planning of any periodontal plastic surgeries performed in the anterior region must take into account the possibility of periodontal defects. Therefore, considering the high prevalence of bone defects with potential impact in the esthetic outcome, the manipulation of soft tissues should be done carefully, especially in patients with a thin periodontium.
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Lin, Jing, Limael E. Rodriguez, Mark Nutley, Lu Jun, Ying Mao, Niraj Parikh, Fanny Alie-Cusson i in. "Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts". Journal of Endovascular Therapy 28, nr 2 (5.01.2021): 300–308. http://dx.doi.org/10.1177/1526602820981980.
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Purpose: To evaluate the response of various stent-grafts after laser fenestration and dilation with noncompliant balloons to determine the optimal therapeutic combination for this treatment technique. Materials and Methods: Five aortic stent-grafts were evaluated ex vivo: the Bolton RelayPlus, Jotec E-vita Thoracic 3G, Medtronic Valiant, Cook Zenith Alpha, and Vascutek Anaconda. Small holes were created using an excimer laser with the grafts submerged in saline. Five rows of 5 fenestrations were created, 4 holes in each row were dilated once with a 6-, 8-, 10-, or 12-mm-diameter noncompliant balloon to the specified nominal pressure (one hole served as the control). The saline solution from each stent-graft was collected and qualitatively analyzed for debris. The fenestrations were evaluated under light and scanning electron microscopes. The maximum diameter and area for each fenestration were measured. The direction and length of tears were assessed. Results: The fenestration was feasible and reproducible in all the stent-grafts. The mean area of fenestration ranged from 7.63±1.63 to 14.75±0.73 mm2 when using balloons of 6- and 8-mm diameter, respectively. The 10- and 12-mm-diameter balloons caused a significant increase in area, variability, and tearing. The Anaconda graft tended to tear in the weft direction, while the other devices tore in the warp direction when using the 10- and 12-mm-diameter balloons. Dilation of the RelayPlus and Anaconda grafts with 6- and 8-mm-diameter balloons provided minimal tearing and precise fenestrations. Melted fiber remnants were observed after filtration of the saline solution for all devices. Conclusion: Laser fenestration and dilation with noncompliant balloons is a relatively simple and reproducible option for revascularization in urgent, complex aortic endovascular repairs. In our model, large balloons (ie, >10 mm) increased the destruction and tearing of the fabric. The maximum dilation recommended is 6 to 8 mm to avoid significant tears. Development of stent-grafts or novel fabrics designed explicitly for fenestration is needed to reduce potential complications.
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Brockenbrough, John M., Sam Marzo, Robert Wurster i M. Rita I. Young. "Bone Wax Prevents Nystagmus After Labyrinthine Fenestration in Guinea Pigs". Otolaryngology–Head and Neck Surgery 128, nr 5 (maj 2003): 726–31. http://dx.doi.org/10.1016/s0194-59980223289-1.
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OBJECTIVE: W e examined the effect of 3 methods of closure of labyrinthine fenestrations. STUDY DESIGN AND SETTING: A guinea pig animal model was developed to examine the effect of 3 methods of closure of labyrinthine fenestrations. These methods included bone wax alone, fascia and fibrin glue, and fascia alone. Nystagmus, a reproducible sign of labyrinthine injury, was chosen as an end point for comparing materials commonly used in human ear surgery. RESULTS: Animals repaired with bone wax showed no postoperative nystagmus, whereas animals repaired with other materials or that underwent canal fenestration without repair showed 3 to 5 days of postoperative nystagmus. CONCLUSIONS: Although it is premature to extrapolate our results to human surgery, postoperative nystagmus can be eliminated in guinea pigs by sealing labyrinthine fenestrations with bone wax. SIGNIFICANCE: Given the intimate relationship between the vestibular and cochlear systems, it is possible that prevention of vestibular irritation might be associated with preservation of cochlear function.
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Dimmick, S. J., i K. C. Faulder. "Fenestrated Anterior Cerebral Artery with Associated Arterial Anomalies". Interventional Neuroradiology 14, nr 4 (grudzień 2008): 441–45. http://dx.doi.org/10.1177/159101990801400410.
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Fenestration of the A2 segment is extremely rare. Cerebrovascular fenestration may be associated with an increased incidence of cerebral aneurysm and other vascular anomalies. Two case reports are presented which identify a fenestration of the A2 segment and other normal variations of the intra-cerebral circulation. A review of the literature has been undertaken to determine the prevalence and embryology of anterior cerebral artery fenestrations, their clinical significance and the association with aneurysm formation and other intracranial vascular anomalies.
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Findlay, J. Max, Mario Chui i Paul J. Muller. "Fenestration of the Supraclinoid Internal Carotid Artery". Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 14, nr 2 (maj 1987): 159–61. http://dx.doi.org/10.1017/s0317167100026317.
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Abstract:A twenty-eight year old woman presenting with subarachnoid hemorrhage was found at angiography to have a left anterior cerebral-anterior communicating artery aneurysm. Also identified was a fenestration of the right supraclinoid internal carotid artery with an associated accessory middle cerebral artery. This appears to be the second reported case of fenestration of the intracranial internal carotid artery. Fenestrations of cerebral vessels and their possible embryologic origins are briefly reviewed.
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Tong, Yuan-Hao, Tong Yu, Min-Jie Zhou, Chen Liu, Min Zhou, Qing Jiang, Chang-Jian Liu, Xiao-Qiang Li i Zhao Liu. "Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease". Journal of Endovascular Therapy 27, nr 3 (czerwiec 2020): 385–93. http://dx.doi.org/10.1177/1526602820917960.
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Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.
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Abdalkader, Mohamad, Christian Raftopoulos, Patrice Finet, Thanh N. Nguyen i Pierre Goffette. "Middle cerebral artery fenestration: Thromboembolic and hemorrhagic complications". Interventional Neuroradiology 25, nr 6 (17.06.2019): 644–47. http://dx.doi.org/10.1177/1591019919857157.
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Cerebral artery fenestrations are rare anatomical variants usually detected incidentally on cross-sectional imaging or cerebral angiography. Although considered benign findings, many reports have described their association with vascular abnormalities such as aneurysms or arteriovenous malformations, and to a lesser extent with ischemic or hemorrhagic complications. We report a case of middle cerebral artery fenestration associated with subarachnoid hemorrhage and middle cerebral artery thrombosis. To our knowledge, there has been no prior report of middle cerebral artery fenestration with a similar presentation.
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Cogger, Victoria C., Irwin M. Arias, Alessandra Warren, Aisling C. McMahon, Debra L. Kiss, Vicky M. Avery i David G. Le Couteur. "The response of fenestrations, actin, and caveolin-1 to vascular endothelial growth factor in SK Hep1 cells". American Journal of Physiology-Gastrointestinal and Liver Physiology 295, nr 1 (lipiec 2008): G137—G145. http://dx.doi.org/10.1152/ajpgi.00069.2008.
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To study the regulation of fenestrations by vascular endothelial growth factor in liver sinusoidal endothelial cells, SK Hep1 cells were transfected with green fluorescence protein (GFP)-actin and GFP-caveolin-1. SK Hep1 cells had pores; some of which appeared to be fenestrations (diameter 55 ± 28 nm, porosity 2.0 ± 1.4%), rudimentary sieve plates, bristle-coated micropinocytotic vesicles and expressed caveolin-1, von Willebrand factor, vascular endothelial growth factor receptor-2, endothelial nitric oxide synthase and clathrin, but not CD31. There was avid uptake of formaldehyde serum albumin, consistent with endocytosis. Vascular endothelial growth factor caused an increase in porosity to 4.8 ± 2.6% ( P < 0.01) and pore diameter to 104 ± 59 nm ( P < 0.001). GFP-actin was expressed throughout the cells, whereas GFP-caveolin-1 had a punctate appearance; both responded to vascular endothelial growth factor by contraction toward the nucleus over hours in parallel with the formation of fenestrations. SK Hep1 cells resemble liver sinusoidal endothelial cells, and the vascular endothelial growth factor-induced formation of fenestration-like pores is preceded by contraction of actin cytoskeleton and attached caveolin-1 toward the nucleus.
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Lounes, Youcef, Lucien Chassin-Trubert, Thomas Gandet, Baris Ata Ozdemir, Antoine Peyron, Mariama Akodad, Pierre Alric i Ludovic Canaud. "Endovascular aortic arch repair with a pre-cannulated double-fenestrated physician-modified stent graft: a benchtop experiment". Interactive CardioVascular and Thoracic Surgery 32, nr 6 (26.05.2021): 942–49. http://dx.doi.org/10.1093/icvts/ivab023.
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Abstract OBJECTIVES The critical step in total endovascular aortic arch repair is to ensure alignment of fenestrations with, and thus maintenance of flow to, supra-aortic trunks. This experimental study evaluates the feasibility and accuracy of a double-fenestrated physician-modified endovascular graft [single common large fenestration for the brachiocephalic trunk and left common carotid artery and a distal small fenestration for left subclavian artery (LSA) with a preloaded guidewire for the LSA] for total endovascular aortic arch repair. METHODS Eight fresh human cadaveric thoracic aortas were harvested. Thoracic endografts with a physician-modified double fenestration were deployed for total endovascular aortic arch repair in a bench test model. A guidewire was preloaded through the distal fenestration for the LSA. All experiments were undertaken in a hybrid room under fluoroscopic guidance with subsequent angioscopy and open evaluation for assessment. RESULTS Mean aortic diameter in zone 0 was 31.3 ± 3.33 mm. Mean duration for stent graft modification was 20.1 ± 5.8 min. Mean duration of the procedure was 24 ± 8.6 min. The Medtronic Valiant Captivia stent graft was used in 6 and the Cook Alpha Zenith thoracic stent graft in 2 cases. LSA catheterization was technically successful with supra-aortic trunk patency in 100% of cases. CONCLUSIONS The use of a double-fenestrated stent graft with a preloaded guidewire appears to be a useful technical addition to facilitate easy and correct alignment of stent graft fenestrations with supra-aortic trunk origins.
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Jiang, Ting, Jian Kai Wang, Yang Yang Jiang, Zheng Hu i Guo Hua Tang. "How well do integrated 3D models predict alveolar defects after treatment with clear aligners?" Angle Orthodontist 91, nr 3 (25.01.2021): 313–19. http://dx.doi.org/10.2319/042220-342.1.
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ABSTRACT Objectives To evaluate the accuracy of integrated models (IMs) constructed by pretreatment cone-beam computed tomography (pre-CBCT) in diagnosing alveolar defects after treatment with clear aligners. Materials and Methods Pre-CBCT and posttreatment cone-beam computed tomography (CBCT) scans from 69 patients who completed nonextraction treatment with clear aligners were collected. The IMs comprised anterior teeth in predicted positions and alveolar bone from pre-CBCT scans. The accuracy of the IMs for identifying dehiscences or fenestrations was evaluated by comparing the means of the defect volumes, absolute mean differences, and Pearson correlation coefficients with those measured from post-CBCT scans. Defect prediction accuracy was assessed by sensitivity, specificity, positive predictive values, and negative predictive values. Factors possibly affecting changes in mandibular alveolar defects were analyzed using a mixed linear model. Results The IM measurements showed mean deviations of 2.82 ± 9.99 mm3 for fenestrations and 3.67 ± 9.93 mm3 for dehiscences. The absolute mean differences were 4.50 ± 9.35 mm3 for fenestrations and 5.17 ± 9.24 mm3 for dehiscences. The specificities of the IMs were higher than 0.8, whereas the sensitivities were both lower (fenestration = 0.41; dehiscence = 0.53). The positive predictive values were unacceptable (fenestration = 0.52; dehiscence = 0.62), and the overall reliability was low (<0.80). Molar distalization and proclination were positively correlated with significant increases in alveolar defects at the mandibular incisors after treatment. Conclusions Alveolar defects after clear aligner treatment cannot be simulated accurately by IMs constructed from pre-CBCT. Caution should be taken in the treatment of crowding with proclination and molar distalization for the safety of alveolar bone at the mandibular incisors.
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Lechanoine, François, Pietro Spennato, Claudio Ruggiero i Giuseppe Cinalli. "Importance of Fenestration Size for Definitive Treatment of a Quadrigeminal Arachnoid Cyst: Endoscopic Inspection of the Cyst and Surrounding Anatomy: 2-Dimensional Operative Video". Operative Neurosurgery 16, nr 1 (18.05.2018): E12—E13. http://dx.doi.org/10.1093/ons/opy122.
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Abstract Arachnoid cysts are fluid-filled sacs, located between the brain or spinal cord and the arachnoid membrane. Their prevalence in children is between 1% and 3%. Quadrigeminal arachnoid cysts represent 1% to 10% of them and are often associated with hydrocephalus, mostly by an obstructive mechanism, explained by compression of the tectum of the midbrain. When an indication for treatment is retained, 3 surgical options are available: microsurgical excision/fenestration, endoscopic fenestration, and shunt placement. Endoscopic treatment is considered the best compromise of definitive treatment with least surgical morbidity, especially because quadrigeminal cysts are located close to the midline, in intimate relationships with basal cisterns and ventricles. We here present the endoscopic treatment of a prenatally diagnosed quadrigeminal arachnoid cyst type III1 with right lateral extension into the middle cerebral fossa, and associated hydrocephalus, treated at the age of 18 mo. Step-by-step detail of surgical technique is presented in original anatomic conditions. Restoration of better cerebrospinal fluid pathways being the objective of this surgery, ventriculocystic, and cyst-cisternal fenestrations were made. Secondary obstruction of the cyst occurred a few months later, requiring further endoscopic treatment to obtain a larger fenestration that allowed good long-term clinical and radiological outcome. The key point of this video is to compare the 2 procedures, stressing the importance of the dimension of fenestrations, to ensure a long-term patency of both stomas. The patient being a child, both parents gave their consent for publication and signed a form.
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Spanos, Konstantinos, Nikolaos Tsilimparis, Franziska Heidemann, Fiona Rohlffs, Christian-Alexander Behrendt, Eike Sebastian Debus i Tilo Kölbel. "Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm". Journal of Endovascular Therapy 25, nr 1 (13.12.2017): 16–20. http://dx.doi.org/10.1177/1526602817745779.
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Purpose: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR). Technique: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR. Since the celiac trunk was already occluded, a 3-fenestration 22-×172-mm stent-graft was chosen to extend the existing stent-graft further proximally. A tapered 38/22-×179-mm Zenith custom-made device was designed for the thoracic component. The technique addresses several issues that arise during a FEVAR-in-FEVAR case, such as the orientation of the new stent-graft and its fenestrations, the absence of space between the 2 devices for maneuvers, and the difficulty in catheterizing target vessels with existing bridging stents, for which a bailout “snare-ride” maneuver is described. Conclusion: FEVAR after previous FEVAR is a feasible and efficient treatment option. The modified “snare-ride” technique can be used to catheterize target vessels in the absence of an Indy snare.
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Satchell, Simon C., i Filip Braet. "Glomerular endothelial cell fenestrations: an integral component of the glomerular filtration barrier". American Journal of Physiology-Renal Physiology 296, nr 5 (maj 2009): F947—F956. http://dx.doi.org/10.1152/ajprenal.90601.2008.
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Glomerular endothelial cell (GEnC) fenestrations are analogous to podocyte filtration slits, but their important contribution to the glomerular filtration barrier has not received corresponding attention. GEnC fenestrations are transcytoplasmic holes, specialized for their unique role as a prerequisite for filtration across the glomerular capillary wall. Glomerular filtration rate is dependent on the fractional area of the fenestrations and, through the glycocalyx they contain, GEnC fenestrations are important in restriction of protein passage. Hence, dysregulation of GEnC fenestrations may be associated with both renal failure and proteinuria, and the pathophysiological importance of GEnC fenestrations is well characterized in conditions such as preeclampsia. Recent evidence suggests a wider significance in repair of glomerular injury and in common, yet serious, conditions, including diabetic nephropathy. Study of endothelial cell fenestrations is challenging because of limited availability of suitable in vitro models and by the requirement for electron microscopy to image these sub-100-nm structures. However, extensive evidence, from glomerular development in rodents to in vitro studies in human GEnC, points to vascular endothelial growth factor (VEGF) as a key inducer of fenestrations. In systemic endothelial fenestrations, the intracellular pathways through which VEGF acts to induce fenestrations include a key role for the fenestral diaphragm protein plasmalemmal vesicle-associated protein-1 (PV-1). The role of PV-1 in GEnC is less clear, not least because of controversy over existence of GEnC fenestral diaphragms. In this article, the structure-function relationships of GEnC fenestrations will be evaluated in depth, their role in health and disease explored, and the outlook for future study and therapeutic implications of these peculiar structures will be approached.
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Banach, Michael J., i Eugene S. Flamm. "Supraclinoid internal carotid artery fenestration with an associated aneurysm". Journal of Neurosurgery 79, nr 3 (wrzesień 1993): 438–41. http://dx.doi.org/10.3171/jns.1993.79.3.0438.
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✓ The case of an aneurysm occurring at the site of fenestration of the supraclinoid portion of the left internal carotid artery (ICA) is reported. A 37-year-old woman presenting with subarachnoid hemorrhage was found to have bilateral ICA aneurysms at the level of the posterior communicating arteries (PCoA's). The patient underwent right-sided craniotomy with uneventful clipping of the right PCoA aneurysm, and attempted clip placement on the contralateral left ICA aneurysm. The follow-up angiogram revealed a residual dome on the left ICA aneurysm, which was noted to originate at the proximal end of a fenestration of the left supraclinoid ICA. This represents the third reported case of fenestration of the intracranial ICA associated with an aneurysm. Intracranial artery fenestrations and their embryological origins are also reviewed.
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Schroeder, Henry W. S. "A NEW MULTIPURPOSE VENTRICULOSCOPE". Neurosurgery 62, nr 2 (1.02.2008): 489–92. http://dx.doi.org/10.1227/01.neu.0000316017.43668.6c.
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Abstract THIS ARTICLE DESCRIBES a new multipurpose ventriculoscope that combines the advantages of several neuroendoscopic systems that are already available and provides some new features. This system can be used for all intracranial endoscopic procedures, such as endoscopic third ventriculostomy, septum fenestration, foraminoplasty, aqueductoplasty, stenting, cyst fenestrations, intraventricular tumor biopsy or resection, or intraventricular cyst or clot removal. The ventriculoscope can be used in both adults and children. Because of its diameter, it is not designed for the endoscopic treatment of newborns.
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Mei, Yuqian, Debao Guan, Xinyu Tong, Qian Liu, Mingcheng Hu, Guangxin Chen i Caijuan Li. "Association of cerebral infarction with vertebral arterial fenestration using non-Newtonian hemodynamic evaluation". Mathematical Biosciences and Engineering 19, nr 7 (2022): 7076–90. http://dx.doi.org/10.3934/mbe.2022334.
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<abstract> <sec><title>Purpose</title><p>Cerebral artery fenestration is a rare vascular anomaly, but its existence has been increasingly documented. The association of cerebral infarction and fenestration is of great clinical interest, and the exact underlying mechanism remains unclear. This study aims to identify risk factors contributing to cerebral infarction by computational hemodynamics analysis.</p> </sec> <sec><title>Methods</title><p>Eight patients with image findings of fenestration structure were recruited in this research, in which four suffered fenestration-related cerebral infarction (A series) while the other four (B series) were set as control matched by the fenestration size. Three-dimensional models were reconstructed from the MRA images and computational simulations with non-Newtonian flow model were performed to get interested hemodynamic characteristics.</p> </sec> <sec><title>Results</title><p>The blood flow pattern was relatively separated along two channels of fenestration in series A compared with series B cases in Group 1-2, however, no significant difference was shown in Group 3-4. Quantitatively, planes were cut in the middle of fenestrations and the ratio of mass flow rate and area was calculated at systolic peak. Results showed that the side of the dominant blood supply was opposite between A and B series, and the dominant side was also opposite between small and large fenestrations. In infarction cases, the basilar top was distributed with larger areas of detrimental hemodynamic indicators and a larger concentrated high viscosity region.</p> </sec> <sec><title>Conclusion</title><p>The flow division condition throughout the fenestration structure has a key impact on further flow redistribution and flow pattern. The blood viscosity has the potential to be a useful tool in identifying the risk factors for cerebral infarction and more emphasis should be placed on the hemodynamic environment at superior cerebellar arteries.</p> </sec> </abstract>
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de Araújo Nobre, Miguel, Armando Lopes i Elsa Antunes. "The 10 Year Outcomes of Implants Inserted with Dehiscence or Fenestrations in the Rehabilitation of Completely Edentulous Jaws with the All-on-4 Concept". Journal of Clinical Medicine 11, nr 7 (31.03.2022): 1939. http://dx.doi.org/10.3390/jcm11071939.
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Background: There is a need for a long-term evidence of implants placed in challenging conditions. The aim of this study was to investigate the outcome of full-arch rehabilitations with the All-on-4 concept for implants inserted with dehiscence or fenestrations. Methods: This retrospective cohort study included 123 patients (dehiscence, n = 87 patients; fenestrations, n = 28 patients; both conditions, n = 8 patients), with a total of 192 implants in immediate function presenting dehiscence (n = 150), fenestrations (n = 40), or both conditions (n = 2). Primary outcome measures were cumulative implant survival (CSurR) and success (CSucR) rates. Secondary outcome measures were prosthetic survival, marginal bone loss, and incidence of biological complications. Results: CSurRs were 94.1% (overall), 95.6% (dehiscence), and 88.1% (fenestrations) at 10 years using the patient as the unit of analysis. Smoking affected implant failure significantly (p = 0.019). Implant-level CSurRs and CSucRs at 10 years were 96.2% and 93.5% (overall), 97.2% and 94.6% (dehiscence), and 90.0% and 87.6% (fenestrations), respectively. Average bone resorption at 5 and 10 years was 1.22 mm and 1.53 mm, respectively. Biological complications occurred in 18 patients (n = 18 implants). Conclusions: Implants inserted with dehiscence or fenestrations demonstrate good long-term outcomes with overall high success and survival rates and low average marginal bone resorption, despite an inferior outcome in implants with fenestrations and smoking’s negative effect.
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Le Couteur, David G., Victoria C. Cogger, Bruce Dobbs i Robin Fraser. "Fenestrations and lipoproteins". Cardiovascular Pathology 20, nr 3 (maj 2011): 191–93. http://dx.doi.org/10.1016/j.carpath.2010.04.007.
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Buyuk, Suleyman Kutalmis, Esra Ercan, Mevlut Celikoglu, Ahmet Ercan Sekerci i Mukerrem Hatipoglu. "Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study". Angle Orthodontist 86, nr 3 (1.05.2016): 431–36. http://dx.doi.org/10.2319/042715-289.1.
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ABSTRACT Objective: To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT). Materials and Methods: CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson’s χ2 and Student’s t-test. Results: The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant. Conclusions: Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.
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Kuroczynski, W., C. Kampmann, Y. H. Choi, D. Pruefer, J. Singelmann, R. Huth, F. X. Schmid, M. Heinemann i H. Oelert. "The Fontan-Operation: From Intra- to Extracardiac Procedure". Cardiovascular Surgery 11, nr 1 (luty 2003): 70–74. http://dx.doi.org/10.1177/096721090301100113.
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Purpose For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation. Methods From January 1995 until April 2002. 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an Intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed. Principal findings There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation. Conclusions Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
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Prathap, Shruthy, i M. S. Prathap. "Interdisciplinary management of mucosal fenestration in two stages – A rare case report with one year follow-up". IP International Journal of Periodontology and Implantology 6, nr 4 (15.02.2022): 234–38. http://dx.doi.org/10.18231/j.ijpi.2021.041.
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Gingival fenestrations are relatively rare phenomenon which results from exposure of tooth due to loss of the overlying bone and gingiva. If left untreated such lesions may act as a source of infection by providing a nidus for bacteria. This case report describes one such case of mucosal fenestration that was managed well using an interdisciplinary approach which included endodontic retreatment, periapical surgery with regenerative approach in the first stage. After 6 months second stage surgery was performed using connective tissue graft. At one year follow up, complete closure of the mucosal defect was found with substantial bone regeneration.
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Bosaeus, Linus, Kevin Mani, Anders Wanhainen i Krister Liungman. "Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator". Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, nr 4 (lipiec 2017): 265–68. http://dx.doi.org/10.1097/imi.0000000000000392.
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Objective By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. Methods This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted. Results This report covers the method when implementing a single fenestration stent graft in pig. Conclusions Successful tests with single and dual fenestrated grafts have been conducted in pigs.
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van Rooij, S. B. T., R. S. Bechan, J. P. Peluso, M. Sluzewski i W. J. van Rooij. "Fenestrations of Intracranial Arteries". American Journal of Neuroradiology 36, nr 6 (5.02.2015): 1167–70. http://dx.doi.org/10.3174/ajnr.a4236.
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Arenas, F. G., i M. L. Puertas. "Fenestrations induced by perfect tilings". Applied General Topology 3, nr 1 (1.04.2002): 77. http://dx.doi.org/10.4995/agt.2002.2114.
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<p>In this paper we study those regular fenestrations (as defined by Kronheimer in [3]) that are obtained from a tiling of a topological space. Under weak conditions we obtain that the canonical grid is also the minimal grid associated to each tiling and we prove that it is a T<sub>0</sub>-Alexandroff<br /> semirregular trace space. We also present some examples illustrating how the properties of the grid depend on the properties of the tiling and we pose some questions. Finally we study the topological properties of the grid depending on the properties of the space and the tiling.</p>
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D’Aloia, Antonio, Enrico Vizzardi, Riccardo Rovetta, Silvia Bugatti, Ivano Bonadei i Antonio Curnis. "Mitral valve rheumatic multiple fenestrations". Journal of Cardiovascular Medicine 16 (styczeń 2015): S98—S99. http://dx.doi.org/10.2459/jcm.0b013e32835ec714.
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Zhu, Caixia, Sofia C. Torres i José Pedro L. Nunes. "Aortic valve fenestrations: a review". Porto Biomedical Journal 5, nr 5 (wrzesień 2020): e083. http://dx.doi.org/10.1097/j.pbj.0000000000000083.
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Saratzis, Athanasios, i Tilo Kölbel. "Fenestrations, Branches, and the Kidney". European Journal of Vascular and Endovascular Surgery 60, nr 3 (wrzesień 2020): 402. http://dx.doi.org/10.1016/j.ejvs.2020.06.004.
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Steier, Liviu, i Gabriela Steier. "Successful Dental Implant Placement Surgeries With Buccal Bone Fenestrations". Journal of Oral Implantology 41, nr 1 (1.02.2015): 112–18. http://dx.doi.org/10.1563/aaid-joi-d-12-00233.
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This is the first comprehensive review of the classification, preventative measures, diagnosis, treatment methods, and determination of success criteria of buccal bone plate fenestrations (BPFs) secondary to posterior implant surgeries. The purpose of this review is to present and discuss the current literature from peer-reviewed journals, recent studies, and international implantology guidelines and to provide practitioners with guiding points to identify and understand whether BPFs are complications or accidents of implant surgeries. In addition, this review sets forth a detailed set of criteria for the evaluation and diagnosis of BPFs and for the subsequent classification of BPFs as either complications or accidents of posterior implant surgeries. From the literature analyzed, it is clear that BPFs are disqualified from the class of implant treatment failures because BPFs neither impair nor significantly delay treatment. A comprehensive outline of preventative measures and surgery aids to avoid fenestrating the buccal bone plate during implant placement, and a variety of repair methods are included in this review. Considerations of treatment outcomes and patient sensitivities are also included in this comprehensive review.
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Greenfield, Jeffrey P., i Mark M. Souweidane. "Endoscopic management of intracranial cysts". Neurosurgical Focus 19, nr 6 (grudzień 2005): 1–9. http://dx.doi.org/10.3171/foc.2005.19.6.8.
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Object Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts. Methods Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration. Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths. Conclusions Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid–containing cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
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Sandberg, David I., J. Gordon McComb i Mark D. Krieger. "Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients". Operative Neurosurgery 57, suppl_1 (1.07.2005): 100–106. http://dx.doi.org/10.1227/01.neu.0000163489.75279.8c.
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Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.
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Lisy, Milan, Guenay Kalender, Guido Rouhani, Matthias Schwarzbach i Wolf Stelter. "Single Centre Experience with Anaconda Custom-made Fenestrated Stent Graft in the Endovascular Repair of the Juxtarenal Aneurysms". Open Cardiovascular Medicine Journal 13, nr 1 (31.05.2019): 31–36. http://dx.doi.org/10.2174/1874192401913010031.
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Aim: The fenestrated Anaconda custom-made stent graft is one of the recently widely accepted fenestrated devices for managing complex juxta- and pararenal aortic pathology. This study showed its feasibility for treatment of challenging juxtarenal anatomy of the abdominal aorta. Methods: Over the period of 12 months, 9 patients with juxtarenal aortic aneurysm underwent fenestrated stent graft implantation in our institution. The graft fenestrations were customized on the basis of computerized tomography (CT-Angiography; CTA). Selected visceral ostia were protected with covered balloon-expandable stents after partial stent graft deployment. The perioperative and short term data were collected prospectively. Results: The mean aneurysm diameter was 58.4 mm (range 46-73 mm). The mean infrarenal neck length was 3.5 mm (range 0-7 mm), no patient had a severe (>60°) angulation of proximal neck. 18 fenestration for renal arteries, 1 for SMA and 3 for coeliac´s were treated with Advanta V12 covered stent. All the target vessels were cannulated successfully through fenestrations and all the stent grafts were successfully deployed in patients with no technical issue in the release mechanism. All the patients have undergone 6 month follow-up, no aneurysm related or aneurysm-unrelated deaths were reported. On the CTA scan, 3 of the patients had a weak type IIb endoleak; no type I or Type III endoleak was demonstrated. All target vessels were open without an instance of branch-stent stenosis/occlusion. No reintervention was needed. Conclusion: The usage of custom-made Anaconda fenestrated stent graft for endovascular treatment of juxtarenal aortic aneurysms is feasible with acceptable intermediate-term results.
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Øie, Cristina I., Viola Mönkemöller, Wolfgang Hübner, Mark Schüttpelz, Hong Mao, Balpreet S. Ahluwalia, Thomas R. Huser i Peter McCourt. "New ways of looking at very small holes – using optical nanoscopy to visualize liver sinusoidal endothelial cell fenestrations". Nanophotonics 7, nr 3 (23.02.2018): 575–96. http://dx.doi.org/10.1515/nanoph-2017-0055.
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AbstractSuper-resolution fluorescence microscopy, also known as nanoscopy, has provided us with a glimpse of future impacts on cell biology. Far-field optical nanoscopy allows, for the first time, the study of sub-cellular nanoscale biological structures in living cells, which in the past was limited to electron microscopy (EM) (in fixed/dehydrated) cells or tissues. Nanoscopy has particular utility in the study of “fenestrations” – phospholipid transmembrane nanopores of 50–150 nm in diameter through liver sinusoidal endothelial cells (LSECs) that facilitate the passage of plasma, but (usually) not blood cells, to and from the surrounding hepatocytes. Previously, these fenestrations were only discernible with EM, but now they can be visualized in fixed and living cells using structured illumination microscopy (SIM) and in fixed cells using single molecule localization microscopy (SMLM) techniques such as direct stochastic optical reconstruction microscopy. Importantly, both methods use wet samples, avoiding dehydration artifacts. The use of nanoscopy can be extended to the in vitro study of fenestration dynamics, to address questions such as the following: are they actually dynamic structures, and how do they respond to endogenous and exogenous agents? A logical further extension of these methodologies to liver research (including the liver endothelium) will be their application to liver tissue sections from animal models with different pathological manifestations and ultimately to patient biopsies. This review will cover the current state of the art of the use of nanoscopy in the study of liver endothelium and the liver in general. Potential future applications in cell biology and the clinical implications will be discussed.
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Golriz, Mohammad, Mohammadsadegh Sabagh, Sara Mohammadi, Omid Ghamarnejad, Elias Khajeh, Markus Mieth, Mohammed Al-Saeedi i in. "PREventive effect of FENestration with and without clipping on post-kidney transplantation lymphatic complications (PREFEN): study protocol for a randomised controlled trial". BMJ Open 10, nr 10 (październik 2020): e032286. http://dx.doi.org/10.1136/bmjopen-2019-032286.
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IntroductionPeritoneal fenestration is an effective preventive method for reducing the rate of lymphatic complications in kidney transplantation (KTx). The size of the fenestration plays an important role in its effectiveness. A large peritoneal window is no longer indicated, due to herniation and difficulties in performing biopsies. Small preventive fenestration is effective but will be closed too early. The aim of this study is to evaluate whether metal clips around the edges of a small fenestration result in optimal effects with minimum fenestration size.Methods and analysisThis trial has been initiated in July 2019 and is expected to last for 2 and a half years. All patients older than 18 years, who receive kidneys from deceased donors, will be included. The kidney recipients will be randomly allocated to either a control arm (small fenestration alone) or an intervention arm (small fenestration with clipping). All fenestrations will be round, maximum 2 cm, and close to the kidney hilum. Clipping will be performed with eight metal clips around the peritoneal window (360°) in every 45° in an oblique position. The primary endpoint is the incidence of symptomatic post-KTx lymphatic complications, which require interventional treatment within 6 months after KTx. Secondary endpoints are intraoperative and postoperative outcomes, including blood loss, operation time, severity grade of lymphocele/lymphorrhea and relative symptoms.Ethics and disseminationThis protocol study received approval from the Ethics Committee of the University of Heidelberg (Registration Number S-318/2017). A Standard Protocol Items: Recommendations for Interventional Trials checklist is available for this protocol. The results will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT03682627).
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Damaty, Ahmed El, Jotham C. Manwaring i Henry W. S. Schroeder. "The guillotine knife: a novel tool for safe endoscopic cutting of intracranial membranes". Journal of Neurosurgery 121, nr 3 (wrzesień 2014): 719–22. http://dx.doi.org/10.3171/2014.5.jns132153.
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This article describes a new endoscopic cutting tool that acts like a guillotine. It enables safe cutting of membranes overlying neurovascular structures because the footplate protects these structures from inadvertent injury. The footplate is introduced under the membrane, elevating it slightly, and then the membrane is cut while pushing the blade down into the footplate. The guillotine knife has been used in various endoscopic procedures such as septostomies, arachnoid cyst fenestrations, colloid cysts resections, and fenestrations of other intraventricular membranes. The authors think that the guillotine knife is a useful addition to the neuroendoscopic armamentarium.