Regional cerebral blood flow after omental transposition to the ischaemic brain in man. A five year follow-up study

Abstract

Regional cerebral blood flow, recorded by the 133Xenon inhalation method, was measured preoperatively and over a five years postoperative period in six patients with completed stroke and stabilized neurological deficits, who had undergone omental transposition for revascularization of the ischaemic brain. Comparisons of the preoperative blood flow values with those recorded following surgery demonstrate a postoperative increase of blood flow in five patients, with a high statistical degree of significance in four of them at the final examination. The flow increase was noted over the infarcted areas of the brain, upon which the omentum had been placed, as well as areas of the ischaemic hemisphere without omental placement and the contralateral hemisphere. Out of the five patients who demonstrated preoperative flow values below the expected norm for age, four showed final postoperative cerebral blood flow within the normal limits for their age. The results are consistent with the assumption that the transposed omentum played a role in postoperative blood flow increase, by adding collateral circulation to the ischaemic brain.

Omental Transposition Decreases Ischemic Brain Damage Examined in a New Ischemia Model

“…Elimination of transient ischemic attacks has already been reported [10][11][12]. Although it was not supported by animal experiments, omental transposition was considered as a therapeutic procedure for patients with completed stroke and stabilized neurological deficits, and some clinical improvements in motor and speech function have been reported [13][14][15][16]. However, Herald et al [17] have been unable to reproduce these findings.…”

“…Therefore, when omental transposition is performed simultaneously with MCA occlusion, infarction occurs before omental revascularization. So, we thought this model was inappropriate to show the beneficial effect of omental transposition seen in clinical studies [12][13][14][15][16]. Therefore, we proposed a new ischemic model where cerebral ischemic deficit is milder than the deficit produced by MCA occlusion because, in the case of MCA occlusion, blood flow is only provided with cortical anastomosis.…”

“…Therefore, MCA occlusion produces a more severe ischemia when compared with ICA and ACB occlusion or vice versa. In previous studies, the patients with sufficient collateral blood supply (due to ICA occlusion or severe stenosis of the ICA or large-caliber vessels), no severe completed neurological deficits, and no evidence of any large infarcted area on computerized tomography have shown clinical improvement [12,13].…”

Traumatic brain injury- Possible beneficial effect of omentum

“…Over the past quarter of a century, there has been increasing interest in using the omentum for a host of neurological conditions, such as stroke [7,8], Alzheimer disease [9,10] cerebral palsy [11], etc. In spite of the use of the omentum in the treatment of a variety of clinical conditions, there has been little, if any, interest in the omentum for the absorption of vasogenic edema in the treatment of a TBI.…”

Omentum transposition for treatment of Alzheimer disease in China

“…A craniotomy is performed and the omentum is simply laid directly on the brain. No anastomosis is involved and there is direct penetration of a large volume of blood which flows from the omentum directly into the brain [9].…”