PNA Spotlight: Dr. João Paulo Almeida, MD PhD

This month the PNA Spotlight focuses on Dr. João Paulo Almeida, the Robert L. Campbell Scholar in Neurological Surgery, Associate Professor of Clinical Neurological Surgery and Director of Skull Base and Pituitary Surgery at Indiana University/IU Health in Indianapolis.  He earned his medical degree at the School of Medicine of the Universidade Federal do Ceará and completed his neurosurgery residency at State University of Campinas. He also trained at Toronto Western Hospital / University of Toronto as a clinical fellow in neuro-oncology and skull base surgery and cerebrovascular surgery. He then served as an advanced endoscopic and open skull base surgery fellow at Cleveland Clinic, in Cleveland, Ohio.  He joined Mayo Clinic in Jacksonville, Florida in 2021, and came to Indiana University last year. Dr. Almeida answered a few questions from PNA. His answers are below.

Please tell us about your educational journey.

I was born and raised in Brazil. I did my original residency training in São Paulo, where I worked with a very well recognized team in microsurgery. In 2016, I came to the University of Toronto in Canada for a fellowship in skull base surgery. I spent two years with that group, and then I went to the Cleveland Clinic in Ohio for one additional year of fellowship. Then I returned to Toronto, and I spent one more year as a cerebral vascular fellow there. In 2021, I joined the Mayo Clinic in Jacksonville, Florida, where stayed for three years as an assistant professor and associate surgeon. In November 2024, I came to Indiana to become the Robert Campbell associate professor of neurosurgery in the Department of Neurosurgery at Indiana University in Indianapolis. I am the director of skull base surgery for the Indiana University Skull Base program, and I am director of skull base programs for the Department of Neurosurgery, and the director of the micro neurosurgery at the Skull Base Laboratory here at Indiana University.

What led you to be interested in pituitary medicine, and who are your mentors?

I have been lucky to have multiple mentors. It all started when I was in medical school. Initially I was trying to find mentors to help me with research, and I was lucky enough to be in a hospital where Dr. Jackson Gondim practiced. Dr. Gondim was one of the pioneers in endoscopic pituitary surgery, and had been doing that type of surgery since 1998 in my hometown in Brazil. Those were the first academic papers of my career. Dr. Gondim is retired now, but we published some of the most impactful papers that I have ever worked on. He taught me the basics of endoscopic skull base surgery and clinical pituitary research.

From there, to continue my interest in microsurgical anatomy, I did my residency training in São Paulo with a world-renowned surgeon who has since passed away, named Dr. Evandro de Oliveira. My main mentor in endoscopic skull base surgery is Dr. Fred Gentilli, from Canada. Dr. Gentilli really helped me to further embrace the importance of endoscopic skull base surgery in the care of our patients. We had a chance to collaborate in many projects, both in Toronto and elsewhere.

What would you like people to know about the pituitary program at Indiana University?

I truly believe in the human touch. That’s the priority in everything we do. I think we should treat people like we would like to be treated, and how we would like our family to be treated. That’s number one. The second point is that we believe in excellence of care, which really comes with a focus on specialized care.  I’m focused on skull base surgery and pituitary surgery, and that’s 90% of my practice. Pituitary is at least 50% of my practice. And finally, we truly believe in the multidisciplinary work that we bring to the table, with a collaboration of ENT and neurosurgery and endocrinology, radiation oncology, neuro-oncology, radiology and much more.

One of the unique things that we have here, is this collaboration between the operating room and the microsurgical anatomy laboratory. Here, we’re very blessed to have a center where I host people from across the nation and the globe. Right now, I have five surgeons: two from Turkey, one from Brazil, one from Italy, and one from Colombia, all training in the laboratory on how to become better at endoscopic skull base surgery. In addition I have my clinic fellow in skull base surgery, who is here from Indiana. That opportunity to really bring into the operating room an understanding of microsurgical anatomy allows us to become better surgeons, but also to deliver better care to our patients.  We educate more surgeons so that they can also deliver excellent results to their patients.

What do you think is the future of neurosurgery: the next big thing?

Right now, many of us are looking at how we can further incorporate artificial intelligence into our practice. A-I can aid the decision-making process and improve our understanding of the behavior of diseases, so that we can better predict tumor behavior and patient outcomes. This is key to current clinical research. We are also looking at the technical aspects of surgery. We are collaborating with other centers to study how artificial intelligence can play a role in identification of structures in the brain and prediction of outcomes in surgery. There are different models that have been demonstrated to be impactful, especially when put in collaboration with pathological, radiological, and clinical data. I anticipate that in the next five to ten years, artificial intelligence is going to become more of a routine to us, rather than the exception.

Please elaborate on how AI can help during surgery.

During endoscopic skull base surgery nowadays, we have surgical video. We can now use that real-time imaging to educate computer-based systems, which can identify structures, for example, in Cushing’s disease. If we train a system well enough, it can help us to differentiate what is normal pituitary tissue from what is not, especially in collaboration with navigation data. So, we anticipate that these systems will become more robust. Our lab has a huge amount of visual data that can be incorporated into A-I systems. Over time, we’re going to be able to use that technology to aid identification of structures such as tumors infiltrating the medial wall of the cavernous sinus, microadenomas, and things that we just can’t see with eyes alone.

What led you to become involved with the PNA?

My first contact with the Pituitary Network Association was two or three years ago, when I was at the Mayo Clinic in Jacksonville, Florida and had a chance to present a webinar to PNA. I had heard of the PNA through some of my colleagues, like Dr. Daniel Prevedello, and others.  So, I’m familiar with the work that is done to educate both patients and providers. Since then, I have spoken at PNA webinars. The PNA has excellent impact within the pituitary patient and provider community.