Omento-myelo-synangiosis in the management of chronic traumatic paraplegia: case report

Post-traumatic syringomyelia: CSF hydrodynamic changes following spinal cord injury are the driving force in the development of PTSM

Post-traumatic syringomyelia (PTSM) is a disorder that occurs infrequently following spinal cord injury (SCI), characterized by progressive neurological deterioration resulting from syrinx expansion originating in proximity to the traumatic epicenter. Several pathogenetic factors are associated with this disorder, however, the precise mechanism of the development of PTSM is controversial. Combined anatomical alterations and molecular changes following trauma to the spinal cord and arachnoid participate in the development of this condition. These factors include narrowing or obstruction of the subarachnoid space (SAS), central canal occlusion, myelomalacia, and alterations in intramedullary water permeability. If a patient sustains a SCI with delayed progressive deterioration in neurological function, in association with the MRI appearance of syringomyelia (SM), the diagnosis of PTSM is straightforward. The treatment of PTSM has not undergone any significant changes recently. The surgical treatment of PTSM consists of reconstructing the SAS or shunting fluid away from the syrinx to other locations. The advantages and disadvantages of each procedure will be discussed. With greater understanding of the mechanisms contributing to the development of SM, including advanced diagnostic methods and further advances in the development of artificial dural and shunting tubing, future therapies of PTSM will be more effective and long-lasting. Incorporation of alterations of AQP4 expression provides an intriguing possibility for future treatment of PTSM.

The evolution of omentum transposition: from lymphedema to spinal cord, stroke and Alzheimer's disease

It is now well established that the omentum incorporates into its tissues a variety of biological factors that exert a favorable effect on the central nervous system. Physiological characteristics of the omentum include edema absorption, fibrotic inhibition, blood-brain barrier penetration and, of major importance, angiogenic activity. Over several decades, studies have shown increasing clinical uses of the omentum following its placement on various structures within the body. This paper details the evolution of omental transposition (OT) up to the present at which time OT is being applied to the brain of Alzheimer disease (AD) patients. Success in this area raises the possibility that the omentum may prove to be a present-day treatment for patients with AD until future pharmaceutical and/or genetic forms of treatment are developed.

Prospective study of omental transposition in patients with chronic spinal injury

OBJECTIVES

This prospective study was designed to assess the effects of omental transposition in patients with a chronic spinal injury.

METHODS

Neurological status was established to be stable and multiple baseline across patient studies were done preoperatively and repeated postoperatively. Assessments included activities of daily living (ADL), functional ability, degree of spasticity, motor power, sensation, pain perception, urodynamic studies, electromyography, sensory evoked potentials (SEPs), and infrared thermography to measure peripheral and general skin vascular responses. Each patient had MRI. Assessments were done at 3, 6, and 12 months after omental transposition in 17 patients.

RESULTS

The detailed assessments failed to show significant improvement, although some patients showed minor objective and subjective change in some categories. Neurological deterioration occurred in one patient. There were 20 surgical complications including urinary tract infection, deep vein thrombosis, wound infection, and incisional hernia.

CONCLUSIONS

Omental transposition has not been shown to improve neurological function in 17 patients with chronic spinal cord injury, and continued use of this operation in this situation is not supported by this study. Further advances in spinal cord repair may utilise the pedicled omental graft to provide an alternative vascular supply, but its current use should be limited to experimental models.

Surgical treatment of thoracic arachnoiditis with multiple subarachnoid cysts caused by epidural anesthesia

We report on a 36 year-old woman who had sensorimotor and sphincter dysfunction 0.5 day after having an epidural anesthesia to deliver her baby. The patients' neurological deficits recovered gradually and she could walk without support 1.5 months after the operation. However, her neurological function deteriorated 4 months after anesthesia and a magnetic resonance imaging (MRI) study revealed spinal arachnoiditis with multiple subarachnoid cysts at the T5-7 levels. Surgical treatment consisted of lysis of adhesions and wide opening of the subarachnoid cysts. Her motor function improved after operation and she could walk without support after a 1 year follow-up. However, her sphincter and sensory abnormalities persisted for the most part. The literature on the surgical treatment of arachnoiditis with myelopathy is reviewed and the surgical indications are discussed.

Omental transplantation in the management of chronic traumatic paraplegia. Case report

A 27 year old male patient with chronic traumatic paraplegia received an omental transplant to the spinal cord. During surgery we found 40 percent of the spinal cord hypotrophied, with vascular alterations and abundant scar tissue. Some neurological improvement already started a few days postoperatively. After 36 months of postoperative follow-up he presents with right crural monoparesis (grade 1-4), deep sensation and with sphincter control.

Syringomyelia and arachnoiditis

Five patients with chronic arachnoiditis and syringomyelia were studied. Three patients had early life meningitis and developed symptoms of syringomyelia eight, 21, and 23 years after the acute infection. One patient had a spinal dural thoracic AVM and developed a thoracic syrinx 11 years after spinal subarachnoid haemorrhage and five years after surgery on the AVM. A fifth patient had tuberculous meningitis with transient spinal cord dysfunction followed by development of a lumbar syrinx seven years later. Arachnoiditis can cause syrinx formation by obliterating the spinal vasculature causing ischaemia. Small cystic regions of myelomalacia coalesce to form cavities. In other patients, central cord ischaemia mimics syringomyelia but no cavitation is present. Scar formation with spinal block leads to altered dynamics of cerebrospinal fluid (CSF) flow and contributes to the formation of spinal cord cystic cavities.