A couple of years ago I wrote about treating AD with omental transposition, a radical therapy with success in ~ 35% of patients in one case series. Today I just noticed that there is a non-randomized, single-arm clinical trial on its use in patients with early stage AD (MoCA score 11-18), in Salt Lake City, UT. Estimated study completion date: May 2019.
This is especially interesting because they have a relatively thorough explanation of how the surgery works. In the general surgery portion of the procedure, an omental flap is created, which receives blood supply from the right gastric and gastroepiploic arteries. Next, a subcutaneous tunnel is created that travels up the chest wall and neck to behind the ear.
In the neurosurgery portion of the procedure, a portion of bone is removed near the temporal-frontal area, followed by removal of the dura and arachnoid membrane. The omentum is then placed on the parietal-temporal-frontal area of one cerebral hemisphere, and connected to the dura via a suture.
Besides this tissue grafting approach, other neurosurgical approaches to Alzheimer’s have included:
- CSF shunts (to the atria or ventricles)
- Intraventricular infusions (of bethanecol, NGF, or GM1)
- Gene therapy with infusion of NGF-expressing cells
- Electrical stimulation (of the vagus nerve, nucleus basalis of Meynert, or the fornix)