I did my neurosurgery training at UCSF, and there I had the good fortune to be exposed to some really excellent pituitary surgeons including Sandeep Kunwar, Manish Aghi, and also Louis Blevins. They are my early mentors in pituitary surgery, and how I got exposure to the PNA. From there, I did a skull base fellowship at MD Anderson and had more specialized training in taking care of lesions on the base of the skull, and pituitary tumors as a part of that.  My practice now is in Kansas City, Missouri, at the St Luke’s Hospital at the Marion Bloch Neuroscience Institute. I’ve been here five years, and we’ve built up a multi-disciplinary team, including endocrinologists, neuropathologists, neuroradiologists, a neuro ophthalmologist as well as my anterior skull base partner, Dr. Vidur Bhalla, who’s a rhinologist trained in skull based surgery.  We have a multi-disciplinary program to help take care of patients with pituitary tumors, because those tumors require a team of highly trained specialists. We have all those people in place, part of a specialized program to help take care of these patients.  We also have a nurse navigator for our program, so when we get referrals or when people call in, especially if there’s an acute symptom like vision loss, we really try to expedite their care. This way they are able to see multiple specialists and get the labs and the imaging they need as a part of the workup, all in the same day. This minimizes the number of trips the patient has to make.

What would you say inspired you to go into this field?

When I started medical school, my background was in engineering. One of the neurosurgeons at Washington University was doing research on brain computer interfaces and the application of engineering technology to try to better understand the brain.  So I spent time doing research in his lab, which exposed me to the culture of neurosurgery. And that’s really where my interest in neurosurgery started. As I went through my training at UCSF and got more actual clinical exposure and training, I developed an interest in pituitary and skull-based surgery.

How would you say your field has evolved?

I think the standards have gone up as the training has gotten better. Certainly, technology has changed. I do surgery endoscopically, but I was trained by people who do it microscopically. The technology in either case is better now, the image guidance has improved.  All of it is better. However, in addition, the bar has been raised for what the outcomes of surgery should be.  These days, there’s a more mainstream understanding that this surgery is really best done by specialists who work as a part of a multi-disciplinary team, which results in better outcomes for patients.  The standards of surgical technique are higher and include pseudo capsular dissection and minimizing residual tumor left behind, doing things like medial cavernous sinus wall resection to ensure that you cure disease for secreting tumors.  With more focus on the disease and more study into surgical techniques, the standards have gone up over time.  It used to be the case 20 or 30 years ago that to really have an expert pituitary surgeon, you had to really travel far.   But now, the training has been disseminated, so now the surgical standard is more uniform across the country.

I imagine the key, first, is to be sure patients get diagnosed correctly and early on.

Yes. There are still those really sad cases where people  have been losing vision for years, and no one realized what was going on, and then they finally figure it out, very late in the game.  But we are raising the bar for pituitary care in the region.  I’m in a more rural area of the country, and someone from a small town just a couple hours away can come here and get expert care. We can take care of their tumor, as opposed to them having to travel across the country to a major center.  We are now providing that level of care in the region.

What made you want to be a part of the PNA?

I like how the organization provides a place for patients to go to find people who specialize in in this type of surgery.  Again, it’s something where you really want to be treated by people who are dedicated to doing this and do a lot of it.   I first heard about the PNA from my mentors at UCSF.