“As I see it, every day you do one of two things: build health or produce disease in yourself.” – Adelle Davis

PNA Spotlight: Dr. Noa Tal

Noa Tal, MD, is a neuroendocrinologist with the Pituitary Disorders Center at Pacific Neuroscience Institute in Santa Monica, California.  Dr. Tal graduated from medical school at Tel Aviv University School of Medicine. She did a residency in internal medicine at Montefiore Medical Center in the Bronx in New York. Later she completed a fellowship in endocrinology at Cedars-Sinai Medical Center in Los Angeles, California. Her research focuses on improving the understanding of clinical outcomes in patients with pituitary disorders, with particular emphasis on long-term outcomes and quality of life.

She was kind enough to answer some questions from the PNA. Her answers follow.

What is your current position?

I’m a neuroendocrinologist working at Pacific Neuroscience Institute at St John’s in Santa Monica. I see patients with pituitary-related disorders both in the outpatient setting for follow-up visits and in the hospital when they are undergoing surgery.

Tell me about your education.

I completed my undergraduate studies in neuroscience at Bar-Ilan University near Tel Aviv, where I met my husband. I then attended medical school at Tel Aviv University. My husband later pursued postdoctoral research in neuroscience at Columbia University, which led us to move to the United States. I completed my internal medicine residency at Montefiore Medical Center in New York, followed by an endocrinology fellowship at Cedars-Sinai in Los Angeles.

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The Power of Practice: 3D Modeling for Pituitary Surgery

In fields from music to sports, rehearsal isn’t just skill-building. It’s foundational to success when the moment to perform arrives. The same is true in medicine. For Mayo Clinic neurosurgeons operating on the extremely delicate pituitary gland, practicing before the actual procedure creates familiarity with complex tumors, often leading to more successful outcomes.

That preparation is especially critical because real-life surgery varies from patient to patient. “No two people have the exact same anatomy,” says Bernard R. Bendok, M.D., Neurosurgeon and Chair of Neurosurgery at Mayo Clinic in Arizona. “Differences in the pituitary gland, surrounding bone, nearby arteries, and membranes all influence how a surgeon approaches each case.”

To bridge that gap, Mayo Clinic is increasingly using advanced 3D modeling—both physical and virtual—to help surgeons plan and rehearse procedures before entering the operating room.

Surgeons have long used mental mapping to build a three-dimensional understanding of a patient’s anatomy from imaging scans. “A good surgeon is able, after reviewing a lot of scans, to build a 3D model in their mind,” Dr. Bendok explains. “Now, 3D printing takes that a step further.” These models replicate patient anatomy using materials that mimic both soft tissue and bone, allowing surgeons to study and even simulate the procedure in advance.

The benefit is simple but powerful: familiarity. By the time surgery begins, the anatomy is no longer entirely new. Surgeons can recognize key landmarks and confirm what they expected to see. As Dr. Bendok puts it, the goal is to “register what you imagined with what’s actually in the field.”

ENT surgeons play a critical role in pituitary tumor removal during endoscopic endonasal surgery. Dr. Devyani Lal, Division Chair of Rhinology and endoscopic surgeon at Mayo Clinic, says, “Patient-specific 3D models give the team a shared view of the route to the gland, helping anticipate challenges, map key landmarks, and align on the safest approach before surgery begins.”

Beyond physical models, Mayo Clinic is also leveraging virtual reality. Using 3D holographic imaging, surgeons can explore anatomy in an immersive environment, including areas where tissue may be more fragile. “Being very gentle and knowing how to avoid injury becomes paramount,” Dr. Bendok says, especially in cases where scar tissue or distortion makes navigation more complex.

These tools are also used for full-team surgical rehearsals. In some cases, surgeons, anesthesiologists, and nurses simulate entire procedures together, including potential complications. “We integrate these models into surgical rehearsal and scenario simulation,” Dr. Bendok says. “When a complication occurs, you learn how to work your way out of a challenge.” The goal is not just to prevent complications, but to ensure the team is prepared to respond effectively if they arise.

This kind of preparation mirrors other high-performance fields. “The goal of surgery is to be proactive and not reactive,” he explains. Like athletes studying opponents or musicians rehearsing difficult passages, surgeons benefit from anticipating what comes next.

For patients, this preparation can translate into meaningful differences in outcomes. Pituitary surgery often requires removing tumors while preserving the function of the gland itself, which is a delicate balance. Advances in imaging and modeling now allow surgeons to better understand how a tumor has displaced or compressed the pituitary, helping guide a more strategic approach.

“One of our goals is to preserve pituitary function,” Dr. Bendok says. “Understanding that in three dimensions allows you to be strategic about how you remove the tumor.” The result can be more complete tumor removal and better hormonal outcomes for patients.

Perhaps most importantly, these technologies are accelerating the learning curve for surgeons and improving collaboration across institutions. Complex cases can be shared, studied, and even rehearsed remotely, expanding access to expertise.

“My outcomes today are much better than they were 10 years ago. That’s experience,” Dr. Bendok says. “But we can accelerate that by engaging physical and virtual models.”

In the end, what may look effortless in the operating room is anything but. Like a finely tuned performance, it’s the result of preparation, repetition, and precision—before the first incision is ever made.

PNA Medical Corner: PNA Medical Corner: Adamantinomatous craniopharyngioma

This month in the PNA Medical Corner we are proud to feature a study co-authored by eleven members of the PNA: Drs. Maria Peris-Celda, Andrew Little, Paul Gardner, Georgios Zenonos, Juan Fernandez-Miranda, Adam Mamelak, Willliam Couldwell, Daniel Prevedello, Nathan Zwagerman, Varun Kshettry, and Jamie Van Gompel. This is the largest group of PNA-affiliated doctors collaborating on a study that PNA staff can ever recall seeing!  The study looks at adamantinomatous craniopharyngioma and finds that surgery achieved gross-total resection in fewer than half of patients.

Adamantinomatous craniopharyngioma: outcomes from a US multicenter registry cohort (RAPID consortium study)

Yuki Shinya ¹, Sandhya R Palit ¹, Maria Peris Celda ¹, Andrew S Little ², Mark A Pacult ², Paul Gardner ³, Georgios Zenonos ³, James Evans ⁴, Juan Fernandez-Miranda ⁵, Adam Mamelak ⁶, Robert C Rennert ⁷, William T Couldwell ⁷, Gabriel Zada ⁸, Albert H Kim ⁹, Julie M Silverstein ¹⁰, Won Kim ¹¹, Marvin Bergsneider ¹¹, Kyle C Wu ¹², Daniel M Prevedello ¹², Nathan Zwagerman ¹³, Stephanie Cheok ¹³, Michael P Catalino ¹⁴, Varun R Kshettry ¹⁵, Michael Karsy ¹⁶, Jamie J Van Gompel ¹

Affiliations Expand

• PMID: 42066361 DOI: 10.3171/2025.12.JNS252065

Abstract

Objective: Adamantinomatous craniopharyngioma (ACP) is a rare type of brain tumor that affects a wide age range, from children to older adults. Due to the rarity of the disease, existing studies are predominantly limited to single-center or single-surgeon experiences, often lacking statistical power and generalizability. The aim of this study was to address this gap by providing a comprehensive analysis of ACP outcomes based on a large multicenter cohort from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID).

Methods: This multicenter retrospective cohort study was conducted via the RAPID consortium and assessed patients with histologically confirmed ACP treated surgically between August 2000 and November 2024 at high-volume pituitary centers across the United States.

Results: Among the 359 patients (206 male, median age at primary surgery of 47 years) included in the analysis, 76% underwent endoscopic transsphenoidal surgery and 22% underwent craniotomy. Gross-total resection was achieved in 45% and subtotal resection in 47%. Notably, 120 of 311 patients (39%) presented with preoperative hypothalamic-pituitary axis dysfunction. Following all treatments, permanent hypothyroidism was reported in 40% of patients, adrenal insufficiency in 33%, and arginine vasopressin deficiency in 19%. Of 263 patients who underwent primary surgery, radiation therapy was administered in 84 (32%). Progression-free survival (PFS) declined from 66% at 1 year to 31% at 6 years. In the multivariable analysis, independent predictors of worse PFS included subtotal resection (HR 0.22, 95% CI 0.11-0.42; p = 0.001), partial resection (HR 0.11, 95% CI 0.04-0.28, p = 0.001), larger tumor size (HR 0.77, 95% CI 0.64-0.94; p = 0.009), and tumor extension beyond the sella and suprasellar regions (HR 0.21, 95% CI 0.06-0.74; p = 0.016). Primary surgery and salvage surgery groups showed comparable PFS.

Conclusions: In this large multicenter cohort study, gross-total resection was achieved in fewer than half of patients and was independently associated with improved PFS. Approximately one-third of patients underwent radiation therapy after primary surgery. These findings provide robust evidence supporting the prognostic value of extent of resection and inform contemporary treatment algorithms for ACP. The high incidence of postoperative endocrinopathy underscores the need for individualized multidisciplinary long-term care. While the retrospective design is a limitation, the multicenter approach enhances the generalizability of these results.

Keywords: RAPID consortium; adamantinomatous type; cohort overview; craniopharyngioma; multicenter study; oncology; pituitary surgery; skull base; surgical outcomes; tumor.

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