Personalized medicine in neurosurgery.

Personalized medicine (PM) in neurosurgery is possible today thanks to newly accessible imaging technologies, and to genomic, proteomic and epigenetic biomarkers capable of providing clinically useful information about individual patients. PM is becoming increasingly indispensable in neurosurgery because this specialty offers a wide range of therapeutic options such as surgery and/or radiotherapy and/or chemotherapy. Moreover, the effectiveness of these procedures varies from one patient to another, depending inter alia on the patients' individual genomic traits. A prime example is glioblastoma multiforme, which exhibits at least five genomic biomarkers related to distinct therapeutic and prognostic outcomes. At least one of these biomarkers, the ω-6 methylguanine-DNA methyltransferase promoter of methylation status, has already been used in clinical trials. New functional imaging techniques allow the surgeon to circumvent crucial brain areas whose location may vary among patients, thus allowing the safe and complete excision of an adjacent tumor. Functional imaging, together with an increasing number of genomic and other 'omic' biomarkers, has also given rise to an improved classification based on molecular signatures of tumors like glioblastoma multiforme that will facilitate the correspondence between type of glioma and choice of biologically tailored-to-patient therapy.