Omental Approach to Functional Recovery After Cerebrovascular Disease.
OBJECTIVE
To review and synthesize the clinical literature regarding risks and benefits of omentum transplantation and transposition surgery in patients with ischemic stroke of other etiology (non-MMD) and Moyamoya disease (MMD), and to evaluate the evidence for biological underpinnings of the presumed physiologic effects of omentum transplantation and transposition on vascularization of brain parenchyma.


METHODS
Articles were searched on scientific databases using predefined key terms. Data abstraction was based on the clinical course as reported in the articles. For further analysis, patients were divided into groups according to their diagnosis (MMD or non-MMD). Descriptive statistics were computed for better integration of the results.


RESULTS
The final literature review contained 15 articles (11 case series, 4 single case studies) with data on 93 patients (29 non-MMD, 64 MMD). At post-assessment 56% of patients showed substantial gains in functional domains (24% in the non-MMD group, 71% in the MMD group) and 92% demonstrated improvements of cerebral vascularization (55% in the non-MMD group, 98% in the MMD group). Differences in improvement became apparent with regard to the initial symptomatology wherein transient ischemic attacks were related to superior recovery rates and language pathologies showed least improvement.


CONCLUSIONS
Surgical revascularization using omental tissue has shown good success rates, particularly for recurrent transient ischemic attacks and prevention of further strokes and should be considered as treatment option for selected patients. Experimental data on the physiologic basis for postoperative improvement delivered convincing evidence for its arteriogenic potential and recent developments in omental stem cell research suggest a role in recovery from long-standing neurological deficits.
Department of Molecular Neurobiology, Graduate School of Behavioural and Cognitive Neurosciences, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany. Electronic address: marekkonieczny@hotmail.de.
Marek J
MJ
Konieczny
Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany.
Song-Jin
SJ
Ri
Department of Neuroscience, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
Janniko R
JR
Georgiadis
D002545:Brain Ischemia / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000601:surgery*; D009072:Moyamoya Disease / Q000601:surgery; D009852:Omentum / Q000637:transplantation*; D020521:Stroke / Q000601:surgery
Cerebral revascularization; Moyamoya; Omentum; Stroke