Pediatric neurosurgery - Science, art, and humility: Reflection of personal experience

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. We know that today's acceptable therapy will likely becomes tomorrow's obsolete. As seen in this reflection of a portion of my life work, some of observations or ideas were later proven to be wrong while others have led to newer treatment concept. Einstein also said, "Anyone who has never made a mistake has never tried anything new." The problem in our profession, however, is that we cannot make mistakes and screw up a child's brain. So, it is so important to conduct careful investigation in the laboratory and develop long-range plans and research/clinical protocol. I still have a lot of ideas and dreams for a better future for the pediatric neurosurgery patient. Pediatric neurosurgery, for me, encompasses science, art, and humility. I love my profession, and I am honored and privileged to take care of another person's precious child. I appreciate the members of ISPN who supported me as your 40th president. And the last but not least, a special thanks to Kathy, my wife of 31 years, who has been a terrific partner, supporting and caring for me in very difficult times (Fig. 5). She has raised our three wonderful sons, Tadaki, Kenji, and Dan, while I was busy, working late most of the time. They are the best of my life and have made my life very rich. I am very proud to call myself "a pediatric neurosurgeon," but I am more proud to be their father and her husband. Without Kathy's presence and support, I would not be here delivering this presidential address. Thanks Kathy.