Pediatric neurosurgery-science, art, and humility: reflection of personal experience.

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I have given you my humble experiences of the managements of representative pediatric brain tumors including various aspects, from clinical to basic research. There is no question in my mind that we have made great strides in diagnosing and treating pediatric brain tumors over the past four decades. Look at medulloblastoma! We are now able to cure 80 % of these children. Unfortunately, however, not necessarily all children live. Still these children with medulloblastoma need cytotoxic therapies which unavoidably cause short or long-term side effects [59]. Could we cure Koh-chan with recurrent craniopharyngioma or a child with DIPG seen 40 years ago in the soap opera? I am afraid the answer is “no.” I did not mention in this presentation about the treatment of craniopharyngioma which still remains controversial in terms of extent of resection: total resection vs. limited resection followed by RT [60]. How about DIPG? There have been absolutely no breakthroughs. Insanity, as Albert Einstein once said, “is doing the same thing again and again and expecting different results.” Progress in molecular biology which enables us to understand tumor origin, character, genetic, and epigenetic features is breathtaking. It is our obligation to identify the safest and most effective therapy based upon current scientific research.