intracranial omentum transplantation

In 1973, Goldsmith first covered the ischemic brain surface with a pedicled omentum to establish a collateral circulation. In 1974, Yasargil freed the omentum to the superficial temporal artery and then covered the surface of the brain to improve brain circulation. At present, intraretinal transplantation of omentum is basically divided into pedicle transplantation and free transplantation. According to data from Alday et al. and Ningxia Medical College, the distribution of the greater omental arteries can be divided into five types: the middle cerebral artery bifurcation is located in the lower third of the type I, and the middle third is the type II, located in the upper 1 /3 is type III, lack of type IV, does not participate in the formation of the gastric retinal arch is V-shaped. Treatment of diseases: cerebral ischemic diseases Indication 1. Occlusive cerebrovascular disease includes transient ischemic attack, intracranial main artery occlusion. Cerebral ischemia caused by extensive intracranial stenosis is most suitable. 2. Abnormal vascular network in the brain. 3. Epidemic sequelae of Japanese encephalitis. 4. There are no arterial or anastomosis failures in the intracranial and extracranial arteries. Contraindications 1. Have a history of abdominal inflammation. 2. The skin of the neck, chest and abdomen is infected. 3. Have a history of seizures. 4. The patient's general condition is extremely poor and cannot be tolerated by this operator. Preoperative preparation 1. Fasting before surgery. 2. The head preparation skin is required according to the craniotomy; the abdominal skin preparation is required according to the upper abdominal surgery; and the surgical side neck and the front chest skin are prepared at the same time. Surgical procedure There were three kinds of reticular omentum transplantation, free omental extracranial vascular anastomosis, and free omental intracranial and extravascular vascular grafting. (1) pedicled omental brain transplantation: 1. Position, abdominal incision: the patient is supine, the head is biased to the opposite side of the operation, and the head and neck, chest and abdomen skin are simultaneously disinfected. A midline or midline incision in the upper abdomen. After laparotomy, the omentum was taken out from the abdominal cavity to observe its morphology, presence or absence of adhesion, deformity, and distribution of blood vessels. 2. Separation of the greater omentum: the omentum and the transverse colon are separated in the avascular zone, and the blood vessels between the gastric curvature and the gastro-retinal arch are cut off from left to right, and the large network is cut according to the type of omental blood vessel distribution. The membrane is brought to the desired length of the head. At this time, the omentum is mainly supplied by the right gastric retinal artery. 3. Transfer of the large omentum flap: the cut pedicled omentum is taken from the upper end of the abdominal incision, that is, under the xiphoid process. At the lead-out site, the rectus abdominis sheath, the rectus abdominis muscle and the abdominal white line are cut transversely by 2 to 3 cm to avoid pressure on the omental vessels leading to the incision and affect blood circulation. Protect the omentum with a warm saline gauze pad and close the abdominal cavity. 4. As a subcutaneous tunnel: make a subcutaneous tunnel in the direction of the ear and neck of the head and neck according to the predetermined abdomen, make a 5cm long transverse incision every 15cm, and use a long forceps to open the subcutaneous tunnel between the two incisions. The large omentum is wrapped around a plastic film to increase the smoothness, and the omentum is gradually pulled out from the inferior subcutaneous tunnel. Avoid retinal torsion or excessive force drag, otherwise it will easily damage the omentum, and even thrombosis, severe cases may cause partial necrosis due to ischemia. 5. Craniotomy, magnifying omentum: After the omentum is determined for laparotomy, a 9×6cm2 horseshoe cranial flap can be made in the head dome area, and the dura mater can be cut and pulled to the head. The pedicled omentum is directly covered on the brain tissue and sutured along the edge of the dura mater. The lower edge of the skull flap must be bitten so that the omentum is not compressed. 6. Guan skull: put back the bone flap, routinely suture the scalp, do not let the drainage. (B) free omental extracranial vascular anastomosis brain transplantation: After the laparotomy, all or the appropriate size of the omentum is removed, and the left and/or right gastric retinal veins and veins are reserved, and the gastric retinal blood vessels are perfused with the heparin saline solution until the effluent is clear. Incision was made in front of the left ear and neck to find the superficial temporal artery and the total facial vein. Under the operating microscope, the right gastric artery and the superficial temporal artery, the right gastric vein and the common venous end were anastomosed. The omentum is passed through the subcutaneous tunnel from the neck to the head to cover the exposed brain surface. Other surgical procedures are the same as pedicled omental brain transplantation. (3) Free omentum intracranial and extravascular vascular bridging brain transplantation: On the basis of the above method, the retinal artery trunk was anastomosed to the selected end of the cortical branch. In this way, the transplanted omentum simultaneously serves as an omental graft and an intracranial and external anastomosis. Other surgical procedures were performed in conjunction with free omental extracranial vascular anastomosis.