CHRISTOS A.GOGOS MD-Phd
Consultant Neurosurgeon-Dir.Neurosurgical Dept.ASKLEPEION VOULA
President of the Hellenic Society OMA group(Olfactory Mucosa Autografts group)
Member of ARGOS spine Soc.
Member of EANS –spine (European Assoc.Neurosurg.Societies)
Member of World Spine Soc(Cleveland Clinic)
Member of the Hellenic Spine Soc.
Member of the Hellenic.Neurosurg.Soc.
Glial scar is a physical-chemical barrier to axonal regeneration. The objective is to fight against the formation of this scar. Neurotrophic factors such as BDNF, GDNF (Cai et all 1999) are beneficial to the surviving nerve cells. A by-pass zone (olfactory cells placement) in the contusion zone after scar removal or in the future (gene therapy) can involve many types of cells (olfactory bulb, glial sheathing cells of the olfactory bulb, stem cells). The olfactory nerve is the only cranial nerve with potential regeneration. Several laboratory studies (Prof. Yoshmin-Japan) reported the capacity of these cells to make the axonal regeneration easier after transplantation in the S.C.I. (Ramon-Cuefo; Imaizum; Lilu) compared to the respiratory epithelium transplanted in rats. In the near future gene therapy will enable us to use custom made cells delivering precise and physiological doses of predetermined substances. Actually, the gene sequences of numerous substances are identified: neurotrophins, neurotransmitters, antiapoptosis factors, structure proteins, molecules of the extracellular matrix. According to Murray et al. (1999), J.
Neuroscience a study has been conducted on animal models about spinal cord hemisection, revealing the objective recovery of motor functions in lower limbs. Antonacci/Murray et al. 2001 SRS, undertook a study on animal models of complete transection of the thoracic cord and observed an axonal regrowth through the transplant, including distal host tissue regrowth for up to several millimeters.
This study demonstrates an improvement over a range of functions in a group of patients with chronic spinal cord injury treated by transplantation of olfactory mucosa autografts in the reported lesion. Previous experiments agree with the clinical results. It is a safe method with no ethical demands. Moreover, it is technically possible to be performed by every skilled neurosurgeon when combined with the abilities of a skilled ENT and anesthesiologist. The management of S.C.I. must remain in its prevention, early rehabilitation after an optimal stabilization. The future is in front of us. OMA transplantation may have a main role in the treatment of these patients (chronic).