An Operation For Alzheimer’s — Omentum Transfers

Circa 2007

Catherine Cain watched her grandmother die from Alzheimer’s disease. “Her death was awful, pitiful and terrible,” she recalls.

When her mother, Ruby Palmer, began to show early signs of dementia: becoming confused, repeating herself and getting lost, Catherine and her father were determined to be proactive about treatment. They got her the latest medication, a drug called Aricept (Eisai/Pfizer).

“For three months that helped,” says Catherine, “then she started to go downhill.”

That’s when she went online to search for innovative procedures, which turned up an operation that she’d never heard of called “omentum transfer.” According to the information she found, a doctor named Harry Goldsmith often performed it. He’s a professor of surgery at the Nevada University School of Medicine.

Goldsmith had spent years researching the omentum, a protective tissue that hangs like an apron over the intestines and lower abdominal area. Rich in blood vessels, it also stimulates the growth of new blood vessels, when grafted onto an area such as the brain or spinal cord.

It’s due to a severe lack of blood flow that a critical mass of cells die in the areas of Alzheimer’s patients’ brains that deal with cognition and memory. With an omentum transfer to that part of the body, blood flow can not only improve, but also provide vital oxygen and nutrients to nerve cells.

Still, any surgery has its risks, and Catherine worried how her mother would fare.

“It was scary, deciding on an omentum transfer,” she recalls. “But we felt it was our only hope. Professor Goldsmith told us he had operated on 23 people with Alzheimer’s, 17 of whom had shown improvement, and the rest of whom had shown significant reversal of their symptoms. My mother was still in the early stages, so we felt she had a chance.”

The operation requires both a general surgeon and a neurosurgeon. Goldsmith prepares the omentum for transer, but relies on a neurosurgeon, such as Dr. Siegfried Vogel of St. Gertrude’s Hospital in West Berlin, to attach it to a particular area of the brain or spinal cord.

During surgery, Goldsmith partially separates the omentum from the intestines, leaving the main blood supply intact. That tissue is then surgically tailored and stretched into a long pedicle, and brought subcutaneously up under the chest wall and neck to the brain. That’s when Vogel removes the flap of omentum tissue and stitches an artery and vein from the omentum to the temple artery and vein in the brain. He describes the operation, with disarming understatement, as “not too easy.” Vogel first introduced Goldsmith to the procedure in 1986 at a conference in Cuba.

Omentum transfer to the brain was first done on chronic, post-stroke patients 25 years ago. The results were generally favorable, and specialized brain scans demonstrated that omental blood vessels grew and penetrated deeply into the underlying brain tissue.

Omentum transfers to the spinal cord soon followed, in an attempt to restore function to those who are paralyzed. Goldsmith had some success in this area, and published MRI scans demonstrating nerve growth after surgery. But an unfavorable study written in 1996 made the operation controversial. As a result, it’s performed less frequently in America.

“One of the problems,” Goldsmith says, “is that for surgery on chronic spinal-cord injury to be effective, it must be followed by aggressive and prolonged physiotherapy.”

As it is used for different neurological conditions, surgeons are learning more about the properties of the omentum. A five-year, follow-up study on those who had undergone its transfer to the brain, showed that it continued to deliver an increasingly large volume of blood, despite the aging process. The omentum also contains plentiful neurotransmitters such as acetylcholine, which are often at dangerously low levels in Alzheimer’s patients.

Vogel describes omentum transfer as a “general help.” Unlike stem-cell transplants, which are particularized for a certain disease, omentum transfer may be “a presentday treatment until future pharmaceutical or genetic forms of treatment are developed,” says Goldsmith.

Anecdotal evidence shows this procedure improves neurological condition, sometimes dramatically, when all other means have been exhausted.

“The first time I performed this operation was in 1980 on a six-year-old child with epilepsy,” Vogel recalls. Each day she had 10 or 12 seizures and was unable to walk or speak. We discovered that the whole left side of her brain had disturbances to the blood supply. We could think of nothing but this omentum transfer to improve it. After the operation, we waited three weeks, and each day she had fewer seizures, until she was able to stand and walk. Within the year she could speak. With continued medication she had no seizures and was able to attend school normally.”

Three months after her own mother’s operation, Catherine reports “small differences.” “She has started to read again, and when I take her shopping, she can get out her credit card, swipe it in the machine and sign it. She could not do that prior to surgery. She no longer asks the same question over and over, and she remembers small things, like my son going back to college. She is not taking any medication and is stable, allowing her more time with my Dad.”

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