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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.

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PNA Medical Corner: PNA Medical Corner: Acromegaly and nearby tissues

This month the PNA Medical Corner features a study coauthored by a member of the PNA: Dr. Manuel Ferreira, vice chair of neurosurgery at the University of Washington Medical Center. The study looks at 113 cases of acromegaly, looking for spread to nearby tissues, and found that microscopic invasion of adjacent tissues is common and can lead to “failure of surgical remission.”

https://pubmed.ncbi.nlm.nih.gov/41317589/

J Clin Neurosci. 2025 Nov 28:143:111771. doi: 10.1016/j.jocn.2025.111771. Online ahead of print.

Tumor characteristics and clinical outcomes in 113 patients with acromegaly: exploratory analysis of the role of histologic invasion of adjacent tissues

Jessica C Eaton ¹, Shreya Swaminathan ², Fatima M El-Ghazali ³, Jacob J Ruzevick ³, Samuel N Emerson ³, Jordan E Perlman ⁴, Olga Lucia Paredes ³, Shaun Saurowitz ³, Thomas Hanks ³, Spencer Raub ³, Kyly Hiatt ³, Eric Lassitter ³, Mallory Tucker ³, Kristen Moe ⁵, Courtney E Francis ⁶, Richard Alan Failor ⁷, Anthony Desantis ⁷, Luis F Gonzalez-Cuyar ⁸, Kathryn Weaver ⁷, Brent Wisse ⁷, Manuel Ferreira Jr ³

Affiliations Expand

41317589  10.1016/j.jocn.2025.111771

Abstract

Background: Acromegaly, almost always caused by growth-hormone (GH)-secreting pituitary adenomas (PAs), leads to significant morbidity and mortality when left untreated. Surgical resection is the gold standard treatment, but biochemical remission following surgery occurs in only 40-60% of patients. We aimed to investigate characteristics of and outcomes in a large cohort of patients who underwent surgery for treatment of acromegaly from a GH-secreting tumor.

Methods: We analyzed a cohort of 113 patients who underwent surgery for resection of GH-secreting PAs at a single institution. We evaluated tumor characteristics and clinical and histopathologic factors affecting remission rates following surgery. Additionally, a smaller cohort of 20 GH-secreting PAs were found to have histologic evidence of invasion of either the bone, mucosa, cavernous sinus walls, or other dura. We investigated the characteristics of invasion and its prognostic value for these tumors.

Results: A total of 113 patients underwent resection of GH-secreting PAs. Histologic analysis revealed invasion of bone, dura, or mucosa in 20 patients (17.7 %). Of the total cohort, 66 patients (58.4 %) achieved biochemical remission with surgery alone. An additional 6 patients (5.3 %) achieved remission with meds, and 5 patients (4.4 %) achieved remission with additional surgery. In patients with evidence of invasion, pre-operative growth hormone levels were higher (32.0 vs 15.5, p = 0.020), tumors were larger (6.2 vs 3.0 cm³, p = 0.011) and the risk of post-operative CSF leak was higher (25 % vs 9.7 %, p = 0.012). There was a trend toward lower odds of biochemical remission in patients with invasive tumors (OR = 0.348, p = 0.058).

Conclusions: In patients undergoing resection of growth hormone-secreting tumor for treatment of acromegaly, microscopic invasion of tissues is relatively common and portends an increased risk of failure of surgical biochemical remission. Identification of microscopic invasion may allow for more aggressive surgical management and better chances of surgical control of disease.

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