The Department of Neurosurgery at Chonnam National University Hospital became independent from the Department of Surgery, and on February 29, 1964, Prof. Jung-Hyun Woo (1929–1993) of the Department of Neurosurgery was inaugurated as the first head professor (Fig. 1A and B). In the early years, brain tumor surgery relied on cerebral angiography, and surgical techniques such as finger extraction were used rather than microsurgery. However, the introduction of brain CT equipment in May 1982 revolutionized preoperative diagnosis and treatment of brain tumors.

In April 1983, Prof. Sam-Suk Kang (1946–2021) returned from brain tumor training in Kyoto University, Japan, and began specializing in brain tumors. To promote academic activities, improve medical services for patients, and enhance education for clinical trainees and medical students, attempts to subdivide specialized fields began for the first time as a provincial university. In the late 1980s, various surgical approaches were attempted for pineal or ventricular tumors that were previously deemed inaccessible. With the help of Prof. Hyunchul Lee of the Department of Microbiology, we operated our own brain tumor tissue bank for basic brain tumor research.

With the introduction of brain MRI in January 1992, the diagnosis of brain tumors became easier and the number of annual surgeries began to increase. Prof. Sam-Suk Kang and Shin Jung had participated in a cadaver dissection workshop held at University of California, Los Angeles, and learned various surgical approaches that could not be attempted due to the poor domestic situation at the time. In February 1993, Prof. Jung-Hyun Woo, who was the head professor at the time, passed away, and Prof. Shin Jung joined the brain tumor section in March 1993. Prof. Sam-Suk Kang served as the 4th president of the Korean Brain Tumor Society in 1994 and contributed greatly to its development.

From October to December 1995, Prof. Shin Jung received short-term training on skull base surgery from Prof. Hakuba of Osaka City University Hospital, laying the foundation for future skull base surgery in the department. The following year, from July 1996, Prof. Shin Jung had studied the molecular biology of brain tumors for two years under the guidance of Prof. James Rutka of the University of Toronto, Canada. Upon his return, Prof. Shin Jung started a brain tumor laboratory at the Medical Science Research Institute, which had been a long-cherished dream of the department. With a large-scale government research fund, the size of the brain tumor laboratory has grown, and the number of researchers has reached five. The main laboratory research filed is the inhibition of brain tumor invasion, and many related papers have been published [1234567891011].

Since his return from training at the University of Toronto in 1999, the number of annual brain tumor surgeries has exceeded 200 cases. As the years progressed, the number of surgeries and research results increased, and many papers were presented and published in domestic and foreign conferences and in SCI-registered journals. In March 2000, the 3rd generation BRAINLAB navigation was introduced for the first time in Korea, and used for many surgeries in the field of brain tumors [1213]. Prof. Shin Jung has actively participated as a board member of the Korean Brain Tumor Society since 1999 and the Korean Skull Base Society since 2003, based on the vigorous academic activities for brain tumor and skull base surgery.

The establishment of Chonnam National University Hwasun Hospital (CNUHH) in April 2004 brought significant changes to the field of brain tumor treatment. Prof. Sam-Suk Kang and Shin Jung, who had managed the brain tumor field at the origin Chonnam National University Hospital, relocated to Hwasun Hospital (Fig. 1C and D). Prof. In-Young Kim and Tae-Young Jung joined brain tumor team at the opening of Hwasun Hospital, which further contributed the clinical and basic fields. Prof. Kyung-Sub Moon in 2007, Woo-Youl Jang in 2010, and Yeong Jin Kim in 2020 joined in turn, accelerating the expansion of the field of central nervous system (CNS) tumors. Hwasun Neurosurgery can perform comprehensive CNS tumor surgery, radiosurgery/radiation treatment, and chemotherapy, manage patients through continuous communication with brain tumor patients, and train residents and educate specialists. Notably, the department started as the first specialized brain tumor center in Korea.

In February 2011, Prof. Sam-Suk Kang, who laid the foundation for the field of brain tumors in the department, retired. Prof. Shin Jung made great contributions to the development of the society, serving as the president of several important organizations, including the Korean Gamma Knife Radiosurgery Society in 2011, the Korean Skull Base Society in 2014, and the Korean Brain Tumor Society in 2017. Under his leadership, the Korean Skull Base Society hosted a joint session with the Japanese Society of Skull Base Surgery, and published a textbook titled Acoustic Neuroma. When Prof. Shin Jung served as president of the Korean Brain Tumor Society, he held a joint conference with the Chinese Brain Tumor Society and published a Korean textbook Brain Tumors (Fig. 2).

Other faculty members of the department have also been active in academic societies. Prof. In-Young Kim served as a board member of the Korean Society of Stereotactic Neurosurgery and the Korean Gamma Knife Radiosurgery Society. Prof. Kyung-Sub Moon served as a board member of the Korean Brain Tumor Society and the Korean Skull Base Society. Prof. Tae-Young Jung also played a pivotal role in the Korean Society of Neuro-Oncology, Korean Brain Tumor Society, and the Korean Pediatric Neurosurgery Society.

After moving to Hwasun Hospital, Prof. Shin Jung served as the chairman of the department from 2004 to 2015. Then, Prof. In-Young Kim took charge for 4 years before being succeeded by Prof. Kyung-Sub Moon (Fig. 1E and F).

Since moving to Hwasun in 2004, the Department of Neurosurgery has made significant changes in its approach to training and subspecialization. A three-year training program was implemented for new brain tumor specialists, with each sub-specialty being defined. The department also created subfields for brain tumors to ensure that at least two staff members were involved in overlapping efforts to eliminate a gap in the medical care in cases of emergency, and at the same time to eliminate indolence caused by monopolizing one field, and to promote the competitive development of surgeries.

Gliomas, metastatic tumors, pituitary tumors, benign brain tumors such as meningioma and schwannomas, spinal cord tumors, and pediatric brain tumors were subdivided into subfields, and gamma knife radiosurgery was allowed to be performed directly by the specialist in charge of the tumor. In addition, a certain amount of seed money was supported from the department when the faculties started laboratory research by selecting basic research topics according to their respective interests. Currently, while running each faculty’s own laboratory, they are running a laboratory with researchers with their own national research funds. These efforts have led to greater depth and expertise in each subspecialty. Overall, the department’s commitment to training and specialization has enhanced the quality of care provided to patients, as well as contributed to the development of innovative research initiatives.

Surgery for benign skull base brain tumors and pituitary tumors has been performed by Prof. Shin Jung, Kyung-Sub Moon, Woo-Youl Jang, and Yeong Jin Kim. Prof. In-Young Kim and Tae-Young Jung have been in charge of the metastatic brain tumors, which are the most common at the Hwasun Cancer Center. Spinal tumors were handled by Prof. In-Young Kim, Woo-Youl Jang, and Yeong Jin Kim. Prof. Kyung-Sub Moon and Tae-Young Jung have been in charge of malignant gliomas, and Prof. Tae-Young Jung are in charge of pediatric tumors (Fig. 3).

Regarding the overseas training of faculty members, Prof. In-Young Kim participated in a clinical fellowship program at the University of Pittsburgh Medical Center for one and a half years in 2007-2008. Prof. Kyung-Sub Moon completed a two-year research fellowship at The University of Chicago Medical Center from 2010. Prof. Tae-Young Jung trained in pediatric brain tumors at the Hospital for Sick Children in Canada for three months in 2009. Prof. Woo-Youl Jang underwent short-term training for three months at the Johannes Gutenberg University of Mainz in Germany in 2014, and a one-year clinical fellowship for endoscopic neurosurgery at the Thomas Jefferson University Hospital from July 2017. In this way, the faculties of Hwasun Neurosurgery have deepened their respective subdivisions through our own training and overseas training in related fields.

Since its establishment in 2004, the CNS Tumor Clinic/Gamma Knife Center has performed more than 600 brain tumor surgeries annually. With state-of-the-art equipment such as the Pentero Microscope (Zeiss), intraoperative neurophysiologic monitoring, neuronavigation (BRAINLAB, Medtronics), cavitron ultrasonic surgical aspirator, Sonostar, neuroendoscope, electromagnetic field system, and electromyography, the center provides the highest level of medical service to patients with a wide range of CNS tumor surgeries, including awake surgery and even the most challenging surgeries.

In our department, we have performed 11,912 brain tumor surgeries (as of December 2020) over the past 40 years since its foundation, and complex surgeries such as skull base surgery account for 43% of the total surgeries, resulting in not only simple quantitative expansion but also high-quality level surgeries. For pituitary tumor surgery, both microscopic and endoscopic transsphenoidal approach are performed, and the use of an endoscope is gradually increasing. The numbers of microsurgeries and radiosurgeries have increased over the years (Fig. 4). Among them, 80% of all brain tumor surgeries have been performed since the opening of CNUHH and CNS Tumor Clinic/Gamma Knife Center has established itself as a specialized medical institution for CNS tumor treatment. Sketches containing detailed illustrations and intraoperative findings have been performed by surgeons immediately after surgery and these sketchbooks stored over the past 30 years are valuable assets for brain tumor surgery data for clinical investigation and education.

Gamma Knife Radiosurgery (Perfexion, Elekta, Sweden) was first performed in June 2004 with Prof. Seung-Jin Park and Dr. Sa-Hoe Lim. The use of the radiosurgery has increased over the years: 1,000 cases in January 2009, 2,000 cases in July 2012, 3,000 cases in December 2015, 4,000 cases in December 2018, and 5,000 cases in 2021. It was performed 376 cases of gamma knife radiosurgery in the last year.

Progress has been made in clinical practice as well as research. With the opening of CNUHH, the brain tumor laboratory also moved to the Hwasun Cancer Institute, further strengthening the role of the research center in the clinical-basic field. In addition to the clinical development of the field of responsibility, young professors can operate a practical laboratory with performing the actual experiments to obtain a degree. A total of 15 doctors and 14 master’s degrees were produced based on the basic research of brain tumors. Among them, Jin Yang Hao, Jin Shu Guang, Pei Jian, Wen Min, Li Song Yuan, Jin Jun, Li Chun Hao, and Liu Zhipeng came from China, and Cao Van Thang, Tran Thi Anh Thuy, and Doung Thi Hoang Oanh came from Vietnam to study and obtain masters and doctoral degrees. Currently, the brain tumor laboratory has developed into a basic brain tumor research group consisting of two full-time research professors, five master’s/doctoral students, and two researchers (Fig. 5).

As the basic research field, Prof. Shin Jung’s recent research focus is “flagellin-based peptide cancer vaccine and radiation combined malignant glioma treatment” as a cancer conquest promotion development project (2017–2021) [14] and “the project to nurture physician scientists and build a precision medical pipeline” (2019–2022) as an innovative doctor for overcoming cancer. Prof. In-Young Kim is conducting additional basic research based on studies of the action of natural killer cells suitable for radiation therapy for gliomas and on vasopressor factors in metastatic brain tumors. Prof. Kyung-Sub Moon has performed MD/PhD cooperation projects from the National Research Foundation of Korea on the “discovery of new molecular targets for overcoming anti-cancer resistance in malignant glioma (2016–2019),” and “discovery of glioblastoma treatment resistance factors based on genome analysis and research on their suppression mechanisms (2020–2023).” Additionally, collaborative joint research with various research groups has progressed including “identification of the role of cancer-related fibroblasts in malignant brain tumors” and “anticancer effects of Lichen derivatives in animal models of malignant brain tumors” [151617]. Prof. Tae-Young Jung conducted the National Research Foundation’s new research (2014–2017) and follow-up research (2017–2020) on the “optimization of branched multi-peptide vaccine function with immunotherapy for glioma” as the main research field and a regional university excellent scientist project (2020–2023) is being conducted on “the mechanism of enhancing the efficacy of an optimized peptide cancer vaccine by irradiation in glioma” [181920]. In addition, Prof. Shin Jung conducted international collaborative research on medulloblastoma and ependymoma with the University of Toronto, and as a result, numerous joint studies were published [212223242526].

Regarding the education of residents, all medical members including residents gather every morning for a conference on reports of admissions and discharges of patients, scheduled surgery, and a journal club. A preoperative conference, which is held every Thursday at 5:00 PM, rechecks the surgical preparation of patients scheduled for the next week. This conference includes a presentation on surgical anatomy and approach related to the upcoming surgeries, followed by a discussion and Q&A session. The chief resident has the opportunity to perform a brain tumor surgery case with a low level of difficulty under the supervision of the professor in charge at the end of the brain tumor program, and is awarded a certificate upon successful completion of the brain tumor program (Fig. 6). In addition, as the building up the humanities of the members, a poem is recited every Monday morning and a background explanation is given on why this poem was chosen. One year, around Teacher’s Day, Dr. Hyul Kim, a resident at that time, quoted a poem, One Jujube Fruit (by the poet, Seok-Ju Jang): “That couldn’t have reddened by itself. A few typhoons inside of it, a few claps of thunder inside of it, a few lightning bolts inside of it, that must be why it’s ripening red…”

Hwasun Neurosurgery was designated as the Asia-Pacific Neurosurgery Training Center of Medtronic in December 2013 and has played an important role in the surgical education of domestic and foreign neurosurgeons. In 2014, Prof. Shin Jung performed a giant skull base meningioma surgery at 115 People’s Hospital in Ho Chi Minh City, Vietnam, in the presence of many local medical staff, which served as an opportunity to enhance the Hwasun Neurosurgical center’s status. Prof. Shin Jung served as the director & CEO of CNUHH from 2017 to 2019, where he contributed to strengthening the hospital’s status by activating an international fellowship system with the International Medical Center. During this time, Dr. Pham Quang Phuc and Le Nguyen Duy Khuong from Vietnam received training on skull base and complex surgeries at Hwasun Neurosurgery (Fig. 6C).

The Hwasun Neurosurgery started a multidisciplinary conference, “Neuroradiopathology (NRP) Conference” with the Department of Pathology and Radiology in 1993, when Prof. Shin Jung joined the Brain Tumor Team, and has continued since the opening of CNUHH in 2004. Prof. Min-Cheol Lee and Kyung-Hwa Lee as neuropathologists, and Prof. Jeong-Jin Seo, Tae-Yoong Chung, and Seul-Kee Kim as neuroradiologists participated together. As a result of the multidisciplinary study in this field, much additional information has been obtained, which is very helpful for research and patient treatment. In the Pituitary Clinic, the multidisciplinary system is mainly followed by pituitary tumor surgery, including endocrinology by Prof. Ho-Cheol Kang and A-Ram Hong, otolaryngology by Prof. Dong-Hoon Lee, neurosurgery by Prof. Shin Jung, Woo-Youl Jang, and Yeong Jin Kim, and neuroradiology by Prof. Seul-Kee Kim. All members work together to provide patient-centered treatment and address postoperative issues in a coordinated manner in a multidisciplinary clinic setting. This approach ensures comprehensive care for patients with pituitary tumors and improves the outcomes of surgery.

Since its opening in 2004, the Hwasun Neurosurgery has been organizing annual symposiums on the latest knowledge in CNS tumor surgery. The purpose of this symposium is to share the accumulated experience of the center with participants and to actively interact with domestic and foreign scholars. Each year, a particular theme or topic is selected, and domestic and foreign experts in the relevant field are invited. In addition, we raised the status of our young professors by having them participate in lectures and discussions, and also gave lecture opportunities to excellent professors in the provinces. Over the years, the Hwasun Symposium has gained a reputation as one of the leading symposiums in Korea, with an increasing number of participants and experts from the diverse field of neurooncology (Fig. 7). Unfortunately, due to COVID-19 pandemic, the face-to-face symposium could not be held in 2020, but it did resume in 2021. The topics of the symposiums held so far covered malignant glioma, parasellar tumor, metastatic brain tumor, vestibular schwannoma, spine tumor, intraoperative monitoring, difficult location of tumor, gamma knife radiosurgery, meningioma, craniopharyngioma, and skull base surgery. Several foreign experts, including Prof. Kenji Ohata, Naokatsu Saeki, and Michihiro Kohno from Japan, Prof. Ying Mao from China, and Prof. Alf Giese from Germany visited and participated in lectures and discussions. The strengths of the Hwasun Symposium include the in-depth treatment of specific topics and ample discussion time, which is why many young neurosurgeons want to attend.

The publication of the Wood Report and Silver Report in 2009 and 2014, respectively, were important milestones in documenting the progress and achievements of Hwasun Neurosurgery over the years.

The “Wood Report” highlighted the medical treatment and research capabilities achieved in the first 5 years since the center’s opening. Similarly, the “Silver Report” recorded the growth and accomplishments of the past 10 years (Fig. 7). Looking towards the future, the author expresses anticipation for the publication of the “Gold Report,” which will summarize the history of Hwasun Neurosurgery for the next 20 years. This report is expected to showcase the continued growth and advancements of the center, as well as its contributions to the field of neurosurgery in the region and beyond.

Since the opening of CNUHH, the center has achieved impressive accomplishments in the field of brain tumor research. As of December 2022, we have published 268 SCI papers and 62 papers in domestic specialized journals related to CNS tumors, authored 9 textbooks, and applied for 7 domestic patents and 2 US patents. In order to share and exchange information with a number of scholars and institutions, these clinical and basic research results have been presented by the World Society of Neurosurgery, the American Society of Neurosurgery, the American Society of Neuro-Oncology, the European Society of Neurosurgery, the European Society of Neuro-Oncology, the American Cancer Society, the Asian Society of Neuro-Oncology, and the Korean Society of Neurosurgery. We presented an average of 65 papers per year at leading domestic and international conferences. Several of the center’s clinical papers have had a significant impact in the field, including the selection of surgical approaches for intraventricular meningioma, emphasizing the importance of indocyanine green videoangiopragphy to measure collateral venous circulation during meningioma surgery, treatment results of microsurgery and gamma knife radiosurgery in small to medium sized vestibular schwannoma which was a paper on the treatment strategies of vestibular schwannomas, and a contralateral approach to tuberculum sellae meningioma. These clinical papers can provide surgical guidelines to many neurosurgeons worldwide [27282930].

Our faculty members have won many academic awards including the best thesis award and excellent oral/poster awards. They have won numerous academic awards (32 times) from the Korean Neurosurgery Society, the Korean Brain Tumor Society, the Korean Pediatric Brain Tumor Society, the Korean Neuro-Oncology Society, the Korean Skull Base Society, and the Asian Neuro-Oncology Society. Among the awards related to brain tumors, the Shim Bo Sung Academic Award has been awarded seven times by Prof. Shin Jung, Kyung-Sub Moon, and Tae-Young Jung. In May 2008, Prof. Shin Jung received the 6th Seobong Medical Award with a special lecture “Brain Tumors: From Bench to Bedside.” This award is given to the professor with the most excellent research achievements in the last two years among faculty members at Chonnam National University Medical School. In 2014, Prof. Tae-Young Jung was selected for the “Yeoui Yeoljeon,” which was for the leading 46 female medical scholars in Korean medicine. In addition, 2014 marked the 50th anniversary of the founding of the Department of Neurosurgery at Chonnam National University Medical School, and all faculty members, led by Prof. Shin Jung as the head professor at the time, were united in cerebrating the event.

The successful strategies of Hwasun Neurosurgery are based on the leadership of the head of the department for determining and respecting the roles of the members, and resolving conflicts within the department. It is also very important to maintain harmony and balance between clinical and basic research. It is believed that the timely introduction of the most advanced medical equipment and efforts to constantly take on the challenges of difficult surgery have a great impact on the reputation of Hwasun Neurosurgery.

The advice to colleagues majoring in brain tumors is to constantly challenge themselves, conduct interesting research, always think about the appropriate treatment for their patients, provide the best treatment, and strive to educate the residents in training.