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A new cerebrospinal fluid (CSF) shunting procedure is presented. By transposing a pedicle graft of the greater omentum to the lumbar CSF compartment, the CSF absorption capacity of the omentum is utilized. The operation is applicable to the treatment of communicating hydrocephalus. The technical problems and physiological effects of the operation have been studied earlier in dogs. This paper presents the first case of an intended clinical series. The patient was studied for 18 months postoperatively by different examinations, including psychometric tests, cisternography, computer tomography, echo-ventriculography, and carotid angiography with measurement of the cerebral blood flow. A gradual improvement in his clinical state was registered after the operation.

Perfusion tests were performed in dogs with a pedicle graft of the greater omentum implanted in the lumbar subarachnoid space to measure its capacity to drain CSF. The CSF pressure was set at different levels in the range 0--50 mmHg and the outflow from a complete CSF space and then from the isolated dural sac was recorded in the same dog with an electronic drop recorder. It was shown that the omental graft could transport as much as 30% of the CSF normally carried by the physiological pathways. The spinal outflow in the controls was virtually non-existent. It is concluded that a bulk flow of CSF occurs through the graft. The results suggest that a lumbo-omental pedicle graft could possibly be used as a biological shunt in the treatment of hydrocephalus.

In a series of dogs, the transport routes of intrathecally administered 99Tcm-DTPA from an omental graft to the venous blood were studied by scintillation probes placed over the portal and external jugular veins and by blood samples from the inferior vena cava. It was found early in the course of investigation that a rich revascularization frequently occurred between the transplanted omentum and the surrounding muscles. In all dogs, the omental graft was divided, in its muscle tunnel about 5 cm outside the dural sac, 13--19 months after the implantation. Even after this a rapid transport to the venous system of radionuclide could be demonstrated. The revascularization of the graft was also studied morphologically in two dogs means of microangiography.

Studies using an experimental cerebrospinal fluid (CSF) shunting procedure are presented. By transposing a pedicle graft of the greater omentum to the lumbar subarachnoid space, the CSF absorption of the omentum can be utilized. Monitoring the absorption of intrathecally administration of 169Yb-DTPA by gamma camera sequential pictures 1 to 17 months after the shunt procedure, a rapid transport of radionuclide from the lumbo-omental shunt to the systemic venous blood was demonstrated.