Surgery for Alzheimer’s Disease: Dream or Reality?

An article entitled: “Omentum Surgery Explored For Alzheimer’s Disease” that appeared on the front page of the March 2014 issue of the General Surgery News is perhaps one of the most fascinating stories of the year. The report describes an operation to treat symptoms of Alzheimer’s Disease that some skeptical clinicians like me might readily disparage as nothing more than an amusing fanciful story lifted from the pages of a mad surgeon’s notebook.

However, the results of a little more than 25 cases performed so far showed close to a 75 percent success rate, success being defined as the marked improvement of the subjects’ cognitive (perception, memory and judgment) function.

This surgery is based on the hypothesis that Alzheimer’s Disease is caused by decrease of blood flow in the part of the brain called the cerebral cortex (roughly, the top of the brain); hence, if the circulation in this region can be enhanced, then conceivably this unfortunate malady can be remedied. The report cites the works of Dr. Harry Goldsmith and other researchers showing that a surgical procedure called “omentum transposition” (OT) could accomplish this.

What is the omentum? It is aptly referred to as an “apron of fat” inside the abdomen that hangs on the front of the stomach and covers the intestines. It is made up mainly of mature yellow fat with abundant blood and lymphatic vessels. The omentum can move around the abdominal cavity to contain any potential “insult” or contamination, such as perforation and secondary infection; this remarkably versatile function has earned this organ the label, “policeman of the abdominal cavity.”

Additionally, because of its rich blood supply, the omentum has been utilized by surgeons to buttress repairs inside the abdomen, to patch defects in areas like the chest and even to vascularize the heart and brain in some stroke victims.

The procedure of omental transposition involves detaching a portion of the omentum from its location below the stomach; then, while keeping its main blood supply intact by a pedicle (pedicle flap), the omentum is tunneled underneath the skin of the chest to the neck and continued behind the ear to reach the brain.

While a general surgeon is performing this procedure in the abdomen, a neurosurgeon opens the skull to expose the brain. After the top of the brain is exposed, the surgery is completed by laying the omentum “like a towel” on the surface of the brain. Then, the wounds are sutured shut and, ta-da, the surgery is finished!

It appears that the surgeons who are pioneering this work are upbeat about the future role of surgery in the management of an illness in which the real cause has not been completely deciphered. There is further interest in finding why the omentum works the way it has been shown, i.e. William Shankle, MD, associate researcher in the Department of Cognitive Science, University of California (UC), Irvine, “thought the omentum’s therapeutic value lay not in its ability to increase cerebral blood flow, but in its capacity to deliver several stem cells and growth factors that promote neurogenesis and neuron survival” (J Surg Res 1997; 67:147-154; Neurol Res 2005; 27: 807-811). There is always a chance that further studies along this line might eventually lead to discovery of the real cause of Alzheimer’s Disease.

Although the procedure seems bizarre, “the results are hard to dispute” according to the author of the article, Victoria Stern. Indeed, this is a promising work, but just like anything in medicine, it would require further research and until the buzzword “randomized controlled study” is satisfied, skeptics would remain the majority.

Reference: Victoria Stern. GENERAL SURGERY NEWS. Issue: March 2014. Vol: 41:03.

Dr. Horatio V. Cabasares is a board-certified general surgeon and Fellow of the American College of Surgeons in active practice in Perry.

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