Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog

Abstract

Perfusion tests were performed in dogs with a pedicle graft of the greater omentum implanted in the lumbar subarachnoid space to measure its capacity to drain CSF. The CSF pressure was set at different levels in the range 0--50 mmHg and the outflow from a complete CSF space and then from the isolated dural sac was recorded in the same dog with an electronic drop recorder. It was shown that the omental graft could transport as much as 30% of the CSF normally carried by the physiological pathways. The spinal outflow in the controls was virtually non-existent. It is concluded that a bulk flow of CSF occurs through the graft. The results suggest that a lumbo-omental pedicle graft could possibly be used as a biological shunt in the treatment of hydrocephalus.

Early application of pedicled omentum to the acutely traumatised spinal cord

“…The omentum has the ability to produce blood vessels that make vascular connections to the pia mater of the normal spinal cord within 72 hours of omental transposition (Goldsmith et ai., 1975;Levander and Zwetnow, 1978). We have observed that vascularisation occurs at an even faster rate when the omentum is applied to a traumatised spinal cord.…”

“…7). This ability of the omentum for absorption has been shown to allow for the transport of 30 per cent of the entire cerebrospinal fluid reservoir through omental channels (Levander and Zwetnow, 1978). Absorption of this central nervous system exudate has been well observed by one of the authors (H. S. G.) following the performance of omental transposition to the brain or spinal cord in hundreds of animals and over a dozen humans over the past decade.…”

Lumbo-omental shunt for drainage of cerebrospinal fluid in hydrocephalus

“…Cisternography with the gamma camera centred over the operative field indicated a rapid transport of 169Yb-DTPA from the lumbar subarachnoid space via the omentum to systemic venous blood 12, 16. iv. In another series of dogs, the capacity to remove fluid from the isolated subarachnoid space at various pressures was studied 15. These studies also demonstrated the large absorptive capacity of the pedicle graft from the omentum.…”

“…It thus seemed logical to examine whether a pedicle graft of the greater omentum placed in contact with the lumbar subarachnoid space could absorb sufficient amounts of CSF to influence a hydrocephalic condition. Before the technique could be safely adopted in clinical practice, the procedure was extensively studied in experimental models 15,16, iv Such experiments demonstrated that there was no overgrowth of vessels, and no adhesions formed between the omental graft and the spinal cord in dogs subjected to the procedure. In dogs observed for 19 months after surgery, there were no neurological deficits.…”

Acute effects of a pedicled omental graft on cold-induced brain oedema in cats

“…This procedure has also been used to treat fixed deficits after cerebral ischaemia and spinal cord trauma in humans 2 ' 16, 18, 22 In addition to these common indications, omental transposition to the brain and spinal cord has been done for a number of other disease processes 1 ' 6, 19. It has been shown repeatedly, in both experimental and clinical situations, that the omentum has an excellent capacity to absorb oedema fluid and cerebrospinal fluid (CSF) 2,6,20,21 The most damaging effects of severe brain oedema are produced in the acute period during and after its formation, and its management should be focused on this period. The aim of our experiment was to investigate the acute effects of omental transposition on focal brain oedema and to explore the possibility of applying it in a clinical situation where brain oedema was not controlled by conventional means.…”