​“What mental health needs are more sunlight, more candor, and more unashamed conversation.” – Glenn Close

PNA Spotlight: Georgios A. Zenonos, MD FAANS

Georgios A. Zenonos is the Neurosurgical Director of the Center for Cranial Base Surgery, Pituitary Center of Excellence, and Center for Cranial Nerve Disorders at the University of Pittsburgh Medical Center Neurological Institute. Dr. Zenonos received his medical degree from the National and Kapodistrian University of Athens School of Medicine. 

He undertook post-doctoral research fellowships at Harvard Medical School in 2010 and at the University of Pittsburgh in 2011. He stayed on and completed his seven-year neurological surgery residency training, as well as an enfolded fellowship in endoscopic and open skull base surgery at the University of Pittsburgh School of Medicine.  He then went on to complete a fellowship in skull base and cerebrovascular surgery at the University of Miami. Dr. Zenonos was kind enough to answer some questions from the PNA. His answers follow.

Please tell us why you chose to specialize in neurosurgery?

I was always intrigued by our nervous system and the brain in particular; they are sort of what makes us who we are. Even in medical school, one of the things that interested me the most was learning about brain and its functions. The surgical specialties were more appealing to me, because you can make a big difference for a patient. It seemed like we were almost preparing to go to war, where it was you and the patient against the disease. It was more physical, and direct way to help patients. In surgery, there is no hiding. The effects of everything you do are so immediate and direct, so it’s quite more gratifying.

Tell us about your early education:

I grew up in Cyprus. Everyone there must do military service after high school. I completed a 26-month period of military service, where I served as a military officer, and then went straight to medical school at the National and Kapodistrian University of Athens. Medical school in Athens is a six-year program.

I then completed a post-doctoral research fellowship in Boston at Harvard Medical School, and then moved to Pittsburgh for my residency, as well as a skull base fellowship, focusing both on endoscopic approaches and open approaches. I then moved to Miami for one year for an additional fellowship in cerebrovascular and skull base surgery. I moved back to Pittsburgh to join the faculty in 2019. 

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Why Teamwork Matters in Pituitary Tumor Care

A pituitary tumor diagnosis often raises immediate concerns for patients, but according to Mayo Clinic endocrinologist Dr. Susan Samson and neurosurgeon Dr. Kaisorn Chaichana, one of the biggest advantages patients can have is a coordinated team guiding every step of their care.

For Dr. Samson, that process begins with reassurance. “The vast majority of these are very benign,” she says. “Patients have an impression they have a brain tumor, and that can cause them extreme anxiety.” From there, the team’s focus shifts to answering two essential questions: Is the tumor affecting hormone production? And is it large enough to threaten nearby structures such as the optic nerves?

That evaluation begins with close collaboration between endocrinology and neurosurgery.

“We really work as a team here,” Dr. Chaichana says. “Dr. Samson does a lot of the workup for our patients with pituitary tumors. If she thinks they need surgery, then she sends them to me. Sometimes I get the patient first, but typically we’re hand in hand 99 out of 100 times. That’s a good reason why we work as a team. We usually come to an agreement on the best approach.”

For Dr. Samson, that partnership extends well beyond making a diagnosis. She has helped develop standardized perioperative protocols that bring together endocrinologists, neurosurgeons, intensive care teams, and nursing staff before every pituitary operation. The goal is to reduce complications, minimize unnecessary steroid use, prevent postoperative hyponatremia, and safely manage patients after they return home.

“One of the things that I brought with me was a really protocolized approach to how we think about a patient perioperatively,” she says. “How do we align how we manage these patients?” She notes that careful coordination has helped reduce complications and prevent hospital readmissions while allowing many patients to recover safely outside the hospital.

Treatment decisions themselves are rarely made by one specialty alone.

“It’s not really clear cut all the time,” Dr. Chaichana says. “That’s why we converse a lot about each of these patients, and we often see patients on the same day or in the same room together to go over that plan.” For nonfunctioning tumors, observation may be appropriate unless the tumor is growing or threatening vision. Functional tumors that produce excess hormones often require surgery, while prolactin-producing tumors are frequently treated with medication first.

Mayo’s multidisciplinary philosophy also changes the patient experience. Rather than seeing specialists one after another over multiple appointments, patients often meet with the entire team during a single visit.

“If the patient comes in at 9:30, they’ll see all of us in the same room at the same time,” Dr. Chaichana says. “We expedite care that way.” He adds that patients benefit from “a team approach,” faster decision-making, and having questions answered immediately instead of waiting for separate appointments.

Dr. Samson believes patients should actively seek out that level of expertise.

“I would really recommend they go to a high-volume pituitary center of excellence,” she says. “Find the right doctor and the right team for you.”

Together, their perspectives reflect a simple philosophy: pituitary tumors may involve complex hormonal, neurological and surgical issues, but when experienced specialists work together from the very beginning, patients receive coordinated care designed to improve outcomes, reduce complications and provide confidence throughout treatment.

PNA Medical Corner: Virtual Dissection Environments

This month the PNA Medical Corner focuses on a study co-authored by Juan Carlos Fernandez-Miranda at Stanford University, a longtime member of the PNA. The study looks at the merits of virtual reality programs that teach the anatomy involved in the endoscopic endonasal approach.

J Neurosurg

. 2026 Jul 31:1-12.

 doi: 10.3171/2026.2.JNS252684. Online ahead of print.

Development and evaluation of a virtual dissection environment for anatomical learning in the endoscopic endonasal approach

Tatsuya Uchida ^1 2, Yuanzhi Xu ¹, Taichi Kin ^2 3, Vera Vigo ¹, Yuhei Sangatsuda ¹, Erik Burgos-Sosa ¹, Masaki Ikegami ¹, Aaron A Cohen-Gadol ⁴, Nobuhito Saito ², Juan Carlos Fernandez-Miranda ¹

Affiliations Expand

• PMID: 42537235  DOI: 10.3171/2026.2.JNS252684

Abstract

Objective: A clear 3D understanding of complex skull base structures, including the cavernous sinus (CS), is vital for the endoscopic endonasal approach. However, traditional learning (TL) methods using textbooks and static materials have limits in fostering spatial comprehension. This study developed an interactive virtual dissection (VD) environment based on a virtual endoscopic skull base anatomy 3D computer graphics (VESA-3DCG) model to enhance 3D understanding of the sellar and parasellar regions and evaluated its educational effectiveness against TL methods.

Methods: The VESA-3DCG model was constructed by modifying previously developed high-fidelity 3DCG models, which were designed with reference to the authors’ previous anatomical studies of the sellar and parasellar regions, and integrated into a VD environment. Twenty-eight Japanese neurosurgical residents (postgraduate years 3-7) were randomly assigned to the VD or TL group. Both learning sessions were conducted remotely via a screen-sharing platform, allowing participants to view and interact with the presented materials in real time. A knowledge test covering four domains-bony landmarks, CS anatomy, microvascular anatomy, and neural anatomy-was administered before and after learning. Gain scores, defined as pre- to posttest improvement, were calculated per domain and overall. Group comparisons were performed to assess learning outcomes, and satisfaction and confidence were rated on a 5-point Likert scale.

Results: The final model, consisting of 304 components and about 18.6 million polygons, accurately depicted the microanatomy of the sellar and parasellar regions. The VD environment supported interactive manipulation, including transparency and translucency control, rotation, zooming, virtual drilling, and retraction. Gain score analysis showed that the VD group achieved greater overall improvement in anatomical learning relative to the TL group (p = 0.036), with the most robust difference observed in the CS anatomy domain (p = 0.001). Within-group analysis in the VD group confirmed notable posttest gains in bony landmarks, CS anatomy, and neural anatomy. Participants reported high satisfaction and confidence with the VD environment.

Conclusions: The VD environment based on the VESA-3DCG model offered an effective, interactive platform for anatomical learning. It demonstrated favorable educational effects, particularly for anatomically complex regions such as the CS, and showed feasibility as a complementary tool to TL, including in remote education settings.

Keywords: anatomy; cavernous sinus; endoscopic endonasal approach; neurosurgical education; pituitary surgery; skull base; surgical neuroanatomy; three-dimensional computer graphics; virtual dissection.

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