Omental transplantation for amyotrophic lateral sclerosis: Case report [Amiyotrofik lateral skleroz i̇çin omental transplantasyon olgu sunumu]

Objective: up to date,the cause of amyotrophic lateral sclerosis (als) is not known. several factors have been etiologically linked with this disease,but none of them with ischemia in the anterior horns of the spinal cord,in the pyramids and in bulbar nuclei of the cranial nerves. the goal of the present study was to place omentum on the medullo-spinal junction to a patient with severe als method: a 60-year-old man with a bulbar form of als received an omental transplantation on the anterior and right lateral surface of the medulla oblongata. during surgery we found: 1) vascular anomalies; 2) atherosclerosis in both v4 segments of the vertebral arteries;3) several exsanguinated perforating arteries over the surface of the pyramids,and 4) hypotrophy of the anterior surface of the pyramids. result: subjective and objective clinical improvement occurred beginning the first day after surgery. this improvement was better during the first days or weeks after operation than in the following months. at present,fourteen months after surgery,the bulbar symptoms have improved by 90% and he can walk at a slow pace with or without assistance. conclusions: these observations suggests that the bulbar form of als is caused by progressive ischemia in the intraparenchymal territory of the anterior-ventral spinal arteries. because,in contrast to this,its revascularization by means of omentum produced neurological improvement.