Intracranial arterial fenestration
Citation, DOI, disclosures and article data
At the time the article was created Jeremy Jones had no recorded disclosures.View Jeremy Jones's current disclosures
Intracranial arterial fenestration refers to segmental duplication of the intracranial arteries. They may be contrasted to arterial duplication, which consists of two distinct vessels with separate origins and no downstream convergence. They are rare anomalies, felt to result from incomplete fusion of primitive embryologic vessels.
Fenestration is the luminal division of the vessel into two separate and parallel channels which rejoin distally 1. Each channel has distinct endothelial and muscularis layers, may be differently sized, and may share adventitial layer depending on degree of embryological fusion 3. Although a fenestration is usually of considered to be of minimal significance, there is an association with aneurysm formation near proximal part of fenestration 2. This is hypothesized to be secondary to focal defects in media layer near sites of channel divergence/convergence 4,5.
Fenestration is more common in the posterior circulation. The rate of fenestrations based on published angiographic series has been much lower than that at cadaveric series. Reported incidence of intracranial fenestration on imaging series is 3:
- 1. Gailloud P, Albayram S, Fasel JH et-al. Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration. AJNR Am J Neuroradiol. 2002;23 (4): 585-7. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 2. Uchino A, Takase Y, Nomiyama K, Egashira R, Kudo S. Fenestration of the Middle Cerebral Artery Detected by MR Angiography. Magn Reson Med Sci. 2006;5(1):51-5. doi:10.2463/mrms.5.51 - Pubmed
- 3. Dimmick SJ, Faulder KC. Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics. 2009;29 (4): 1027-43. Radiographics (full text) - doi:10.1148/rg.294085730 - Pubmed citation
- 4. Cooke DL, Stout CE, Kim WT, Kansagra AP, Yu JP, Gu A, Jewell NP, Hetts SW, Higashida RT, Dowd CF, Halbach VV. Cerebral arterial fenestrations. (2014) Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences. 20 (3): 261-74. doi:10.15274/INR-2014-10027 - Pubmed
- 5. Sanders W, Sorek P, Mehta B. Fenestration of Intracranial Arteries with Special Attention to Associated Aneurysms and Other Anomalies. AJNR Am J Neuroradiol. 1993;14(3):675-80. PMC8333398 - Pubmed