PNA Spotlight: Dr. Fredric B. Meyer

This month the PNA Spotlight focuses on Fredric B. Meyer, M.D., a consultant and professor of neurologic surgery and enterprise chair of the Department of Neurologic Surgery at Mayo Clinic in Rochester, Minnesota.  He holds the Alfred Uihlein Family Professorship of Neurologic Surgery. He is also the Juanita Kious Waugh Executive Dean of Education of the Mayo Clinic College of Medicine and Science, and Dean of the Mayo Clinic Alix School of Medicine.  He studied biology at the University of Pennsylvania, earned his MD at Boston University, and completed residency and fellowship in neurologic surgery at the Mayo Clinic School of Graduate Medical Education, which is part of Mayo Clinic College of Medicine.  He was kind enough to answer questions from the PNA; his answers follow.

Tell me about your educational journey.

I went to college at University of Pennsylvania and then to medical school at Boston University. I completed seven years of neurological surgery training at Mayo Clinic along with several fellowships before staying on staff at Mayo. I trained with Dr. Edward Laws, who taught me much about skull base and pituitary surgery.

What inspired you to choose this career path?

I was inspired in medical school by a neurosurgeon there named Dr. Edward Spatz.  What happens to most medical students is they get inspired by an individual or two, and that directs them into their professional career. In my case, it was Dr. Edward Spatz at Boston University. I was fortunate to get accepted to neurosurgery residency at Mayo Clinic and train under a cohort of inspirational and technically innovative neurosurgeons including Dr. Edward Laws, Dr. Thoralf Sundt, Dr. Patrick Kelly, Dr. Michael Ebersold, and Dr. Burton Onofrio.  These neurosurgeons were inspirational. I have been a Mayo staff neurosurgeon for approximately 30 years and have performed close to 10,500 operations, including surgeries on over 2,500 pituitary tumors.

What message would you like to convey to your patients?

Well, I think one of the beautiful things about Mayo Clinic is that we are an interdisciplinary practice. Basically, all our patients diagnosed with pituitary tumors are first evaluated by an endocrinologist who specializes in pituitary conditions. This includes children who are seen by pediatric endocrinology. If surgery is required, we perform the surgery with a team-based approach, which includes a core group of ENT skull base surgeons and subspecialty neuro-anesthesiologists. We also have a group of pathologists who have subspecialty expertise in pituitary tumors that analyze tissue harvested from surgery.  This collaboration is critical in providing the best patient outcomes.  After surgery, we follow our patients, but importantly, so does the endocrinologist. We also try to coordinate with local endocrinologists and health care providers because we recognize that it can be a long trip returning to Mayo Clinic. We prioritize long-term continuation of integrated care to get the patient back home with an optimal outcome.

We have an extremely large clinical and surgical practice at Mayo Clinic, which means that patients are managed by highly experienced physicians. Unfortunately, not all pituitary tumors can be cured with surgery or medication, so sometimes we need to consider other therapies like radiation. We have several different options, including gamma knife and proton beam radiation. We have two proton beams at Mayo Clinic in Rochester and one at our Mayo Clinic Phoenix, Arizona campus. Proton beam provides very focused radiation with less morbidity.  Collaboration is the heart of what we do, and it is a very important component of taking care of patients diagnosed with pituitary tumors. We have three locations: Mayo Clinic in Rochester, Minnesota, Mayo Clinic in Jacksonville, Florida and Mayo Clinic in Arizona. We collaborate with our colleagues across the three sites and sometimes have patients travel to another site if needed for their care.  We are optimistic that this will provide additional therapies for patients suffering from complex diseases.  I think that it is important to mention that Mayo’s motto is “the needs of our patients come first”.  The investment of complex technologies to facilitate patient care is testimony to this vision.

What do you consider to be the future of your field?

We do a lot of minimally invasive and endoscopic surgery. We have an outstanding skull base dissection laboratory in which we practice and perfect complex skull base approaches.  I anticipate that we will introduce complex robotic approaches that will first be tested in the dissection laboratory. With functioning microadenomas, especially in children suffering from Cushing’s Disease as an example, preoperative identification of the tumor or lesion increases the success of surgery. However, it is not uncommon for a high-resolution MRI (including 7T) to be non-diagnostic.  We are now using other imaging modalities in combination with MRI, including photon CT.  I am optimistic that AI analysis of imaging may prove to be beneficial, and we are directing significant resources into that effort.  Lastly, for pre-operative planning, we are also using immersive 3-D visualization to ensure the safest surgical approach.

How will AI be helpful?

AI is going to be critical in helping delineate radiographically the location of microadenomas. Sometimes imaging is negative. However, if you have the ability to use AI as a tool to assist with reviewing imaging, we can leverage AI’s abilities and say, “Aha, that microtumor is located right over there,” which can be really helpful in both diagnosing and treating patients.

We continue to develop new imaging such as photon CT with the hope that it will facilitate surgery for microadenomas, notably Cushing’s Disease. Our practice at Mayo Clinic in Rochester, Minnesota has begun using CT spectroscopy to better identify location of tumors. However, I am hopeful that AI applied to 7T MRI will be a step forward. Mayo Clinic is also leveraging AI through Mayo Clinic Platform. As new technologies create novel opportunities, Mayo Clinic Platform is harnessing these new technologies to change how care is provided. leading the way for earlier diagnosis, more accurate diagnosis, more personalized care, and more.

What should patients know more about? What deserves more awareness?

In my opinion, if you need pituitary surgery, it should be performed at a center that offers a multidisciplinary, team-based approach. You need to have excellent endocrinologists, radiologists, and skilled surgical teams available to provide safe and effective surgery.  You should also seek care at institutions that offer effective alternative modalities such as focal radiation, if medication or surgery is ineffective.