Anesthesia

Introduction: The surgical placement of an intact vascularized omental pedicle directly on the human brain can result in a significant  increase in cerebral blood flow (CBF). Placing an omental pedicle on the brain of Alzheimer (AD) patients, who are known to have a decreased CBF, may explain the cognitive improvement that has followed this surgical procedure.

 

Methods: The omentum is surgically lengthened with its blood supply remaining intact. Following this lengthening process the omentum is brought up through a subcutaneous tunnel placed along the chest and neck up to the head. A craniotomy is performed and the dura mater is opened. The omentum is then simply laid on the brain without the need for any anastomoses.

 

Results: Omental transposition (OT) to the brain allows omental arteries to penetrate directly and deeply into the brain resulting in a marked increase in CBF. Of twenty-five advanced Alzheimer patients who underwent OT to the brain six patients showed no postoperative improvement, ten demonstrated slight changes with nine patients demonstrating marked cognitive improvement.

 

Conclusion: There is increasing interest that AD is the result of decreased CBF which negatively effects the intra-neuronal mitochondria which directly influences the production of neuronal adenosine triphosphate (ATP) which is the energy source of neurons. The increased CBF originating from the omentum may explain the improved cognition that has followed OT to the brain of AD patients.