Omental transposition to bypass the blood brain barrier for delivery of chemotherapeutic agents to malignant brain tumours: preclinical investigation

Primary neoplasms of the central nervous system (CNS) occur with an approximate incidence of 4.5 cases per 100 000 population annually, and approximately 25% to 35% of these tumours are malignant (1,2). Despite aggressive new approaches in treating these lesions, the mortality rate has not changed dramatically over the past ten to 15 years. This is extremely disappointing when one considers that patients succumb to this disease due primarily to the effects of local recurrence and subsequent mass effect (1). Malignant gliomas rarely metastasize outside the CNS (3), and, indeed, infrequently result in death due to cerebrospinal fluid dissemination and/or multicentricity. Hochberg (4) demonstrated that 90% to 95% of recurrences of malignant gliomas occur within two centimetres of the contrast enhancing margin as depicted by computed tomography (CT) scans.