Long-Term Follow-Up of Omental Cranial Transposition to Bypass the Blood-Brain Barrier for Recurrent Glioblastoma: A Case Report and Scientific Rationale

TL;DR

A patient with recurrent glioblastoma had a 30-month survival after a novel surgery that uses omental tissue to bypass the blood-brain barrier.

Contribution

This case report presents long-term survival data using omental cranial transposition for recurrent glioblastoma.

Findings

The patient had 21 months of progression-free survival and 30 months of overall survival.

Omental neovascularization may help bypass the blood-brain barrier and improve tumor control.

Omental-derived immune cells may recognize tumor antigens and penetrate the tumor microenvironment.

Abstract

Recurrent glioblastoma multiforme (GBM) is associated with a very poor prognosis due to the limited efficacy of existing therapies and constraints of blood-brain barrier (BBB) permeability. Particularly in the recurrent setting, there is no uniform standard of care treatment. In one of the proposed treatments for recurrent GBM, a laparoscopically harvested omental free tissue autograft is used to favor neovascularization and bypass the BBB, in which patients receive an autologous abdominal omental tissue intracranially following attempted gross total resection of the tumor. In this paper, we report the long-term survival and follow-up data of a patient who underwent this procedure. The progression-free and overall survival were 21 months and 30 months, respectively. We hypothesize that neovascularization from the omental flap helps bypass the BBB, and omental-derived autologous immune cells help penetrate the tumor microenvironment and recognize tumor-associated antigens, thus providing better tumor control for recurrent GBM.

Figures