Omental-Cerebral transposition

Omental-cerebral transposition is a surgical technique used infrequently for cerebral revascularization. Experimental evidence suggests that omental grafts confer cerebral protection by increasing cerebral blood flow and possibly through the reduction of cerebral edema and the secretion of various nutritive factors. The procedure itself may be performed by using a pedicled omental graft tunneled from the abdomen or by free omental graft with a microvascular anastomosis to the superficial temporal artery and vein. Although no prospective, randomized clinical studies have proved its efficacy, various case reports and small case series suggest that omental transposition may be useful in specially selected patients with ischemic cerebrovascular disease refractory to more conventional therapies. In patients with occlusive disease of the proximal intracranial vasculature, evidence of impaired hemodynamic reserve, and symptoms unresponsive to medical management, omental-cerebral transposition may be valuable when other surgical revascularization procedures an unavailable or have failed. In addition, encephalo-omental synangiosis may play a role in the surgical treatment of patients with moyamoya disease who remain symptomatic after other more direct revascularization procedures have failed.