The role of neurosurgeons for brain tumor survivors

Abstract

Childhood and AYA generation brain tumors, especially malignant brain tumors, were considered incurable. Increase of treatment intensity aimed for cure has been most important subjects recently. However, recent advancements in surgery, radiation therapy, chemotherapy and molecular target therapy have improved the prognosis of malignant brain tumors. This results in increasesed number of brain tumor survivors and their quality of life（QOL）has begun to attract attention. Accumulated data on long‒term follow‒up of brain tumor survivors revealed many problems including late effects that are directly related to QOL. The late effects of brain tumor survivors are：cognitive impairment, neurodevelopmental disorders, endocrine deterioration, spinal deformity, short stature, cranial deformity, early fusion of sutures, tooth disease, infertility, anemia, neuropathy, epilepsy, vasculopathy including Moyamoya syndrome, cavernous malformation, secondary tumors, leukoencephalopathy, cystic malacia, and so on. To minimize these late effects and treatment sequelae, neurosurgeons need to learn minimally invasive surgical techniques, optimal monitoring, latest diagnostic techniques, genomic medicine, multidisciplinary treatment（e.g. advancement of radiotherapy including proton therapy, chemotherapy, molecular target therapy and so on）. Since the late effects on brain tumor survivors are wide‒ranging, it is essential to establish a long‒term follow‒up system with interdisciplinary approach to health care. By understanding the current status of brain tumor survivors, neurosurgeons can plan treatment of pediatric and AYA generation brain tumors from a long‒term perspective, and have an important perspective for development of future treatment strategies.