Summary of the results
Investigating the differences in survival times of musician and non-musician patients with a malign cerebral tumor is a central aspect of this present study. In this paper, musician’s brains affected by malignant brain tumors were investigated by looking at the survival times of a total of n=47 such patients reported in the literature, and concluded that “there is an interaction between music and brain anatomic structures.” Different survival times for musician and non-musician patients are the key result of the present study. The difference was statistically significant (p<0.05) (table 1).
Survival status:
Glioblastoma multiforme is the most frequent and most malignant primary brain tumor in adults[6],[7]. It confers a poor prognosis[8] despite good surgical resection and medical therapy. Its median survival is 14 months. Therapeutic resistance and tumor recurrence after surgical removal may be a cause of the poor prognosis. Recent studies herald important advances in our understanding and management of malignant cerebral tumors, but understanding mechanisms of progression and recurrence of these tumors are still not sufficient. Different survival statuses in this study between musician and nonmusician groups in an important finding. The mean survival of this group is 20.06 months; however, it was 13.10 months non-musician group (table 2). A multidisciplinary therapy approach including surgery, radiotherapy, chemotherapy was performed in this patient group. The exact diagnosis of the non-musician malign tumor group (Group 2) was GBM. Age and gender were not different between the musician and non-musician groups (table 3). However, the survival status of musicians is better than this non-musician-group. The difference in survival was statistically significant between musicians and non-musician (p<0.05).
Neuroplasticity of the Musician’s Brain
Music is one of the unique abilities of the human brain. Music therapy may be used with positive results[4]. The novel coronavirus disease 2019 (COVID-19) is a global pandemic with international concern[9]. Music may reduce anxiety and stress in this pandemic. Great skills are required for playing a musical instrument. To examine the outcomes of a study, it is necessary to have testable hypotheses[10]. Outcomes are then expressed about the implied goals[10]. Long musical training of musicians may affect the neuronal functions and organization of the brain and some functional and structural changes may occur. Musicians, because of the different anatomic structures of their brains are an excellent model to investigate[11]. Currently, MRI can demonstrate some different cerebral structural changes of musicians. There is good interaction between music and neuroscience[3]. Several factors such as the neural development genes of humans and their regulators might play critical roles in the pathogenesis and treatment of malignant cerebral tumors, which is likely different in the studied groups of this study. The brain with GBM may exert complex changes, and this study indicates that there are differences in the survival status of musicians and nonmusicians with malignant cerebral tumors depending on music education-related potential changes.
The plasticity of the brain with malign tumors
In the medical literature, the consequences of craniotomies, neurosurgical interventions musicians' activities have been published [12],[13], [14],[15], [16]. [17], [18]. Our clinical practice is being guided by scientific principles[19],[20]. After the damage to the brain by a tumoral lesion, a functional reshaping with clinical recovery shows the plastic potential of the brain. The functional outcome means the alterations in how the patient functions or feels after cerebral tumor surgery. The functional outcome cannot be the same in musician and nonmusician patients with cerebral tumors. Early music learning and active music-making can help a damaged brain to recover. In this study, longer survival times of the musician's group may be related to the plasticity of the musician’s brain. Because of the greater brain plasticity of musicians, the recovery of musicians with cerebral tumors can be different from the recovery of non-musician. The mirror neuron system is a brain network implicated in the understanding of action and imitation[21]. This system may activate in some situations such as playing a musical instrument, maybe different in musician people than non-musician and affect the outcome of patients with malign cerebral tumors. This subject should be investigated.
The effect of Neuroplasticity
Neuroplasticity means a remodeling of the brain, and it is underestimated in neurosurgical practice. It is increasingly acknowledged that the brain is highly plastic[22]. The brain has a capacity for reorganizing itself[23]. The picture shows a reorganization of the brain after musical training (see figure). The conventional approach in our clinical practice is to determine the response of the cerebral tumor to surgical and nonsurgical management, but brain plasticity itself may have a role in the response of the patients. Musical training may affect the plastic potential of the brain. Some differences in anatomic structures between musicians´ and non-musicians' brains have been reported[24]. Musical training leads to a good functional network of regions both in the left and in the right cerebral hemisphere[25]. Studying and performing music leads to some changes in the brain. An increased grey matter volume of the musician has been reported[26]. In musician's brains, the planum temporale of the left and the right side is larger than in nonmusicians[27], [28]. Thicker corpus callosum has been reported in musicians who begin their training at an early age [27],[29]. Our study shows that there is a possibility that musicians have the potential of unique brain structure and brain plasticity according to non-musicians. The figure shows the reorganization of the brain after musical training. We are the first time reporting the evidence of prolonged overall survival of musicians. If indeed one is the first to report something and that something is of value[30].