“Let thy food be thy medicine and thy medicine be thy food.” – Hippocrates

PNA Spotlight: Dr. Shaan Raza

This month the PNA Spotlight focuses on Dr. Shaan Raza, Professor of Neurosurgery and Neurosurgical Director of the Multidisciplinary Skull Base and Pituitary Program at The University of Texas MD Anderson Cancer Center in Houston.  He is also Section Chief for Skull Base Surgery and Vice-Chair in the Department of Neurosurgery. He attended medical school at Johns Hopkins in Baltimore, where he also did a neurosurgery residency.  Then he went to MD Anderson to do a skull base fellowship. Later he went to Cornell New York Presbyterian in New York City to do an endoscopic skull base fellowship.  After concluding his training, he began practicing at MD Anderson.  Dr. Raza was kind enough to answer some questions from the PNA. Here are his answers.

Please describe your practice.

I’m neurosurgical director of our multidisciplinary skull base and pituitary programs, and so my entire surgical practice focuses on skull base pathology, including pituitary pathology.

What inspired you to go into that field?

Specifically, within neurosurgery, I thought that the management of skull base and pituitary pathology was the most interesting from the standpoint that with the right treatments, you can really make an impact on patients in terms of their quality of life, such as restoring vision, restoring pituitary gland function, and improving survival. What also fascinated me about pursuing this area within neurosurgery is the tumor biology. We knew so little at the time when I was going through training compared to how much more we know now. It is such a rapidly evolving field. But also, I am interested in the surgical strategies, these highly intricate procedures that require an extremely thorough understanding of anatomy and require a lot of focus and intensity.  With the right surgical strategies, you really can make a difference in patients’ lives. So for all those reasons, I wanted to be part of this evolving and innovative field.

Read More Here

How Virtual and Augmented Reality are Transforming Pituitary Surgery

Pituitary tumors can drastically impact the quality of patients’ lives. Some disrupt hormone production, causing symptoms throughout the body. Others grow large enough to press against the optic nerves, leading to vision problems. While surgery is often necessary, it’s far from simple. The pituitary gland is surrounded by delicate and vital structures. Even small differences in individual anatomy can turn a straightforward procedure into a complex challenge.

Now, thanks to emerging advances in virtual and augmented reality, surgeons can plan and rehearse these procedures with a level of precision and personalization previously not possible.

“The secret of successful pituitary surgery is to really understand the nuances of the individual patient’s anatomy,” says Dr. Bernard Bendok, Neurosurgeon and Chair of Neurosurgery at Mayo Clinic in Phoenix. “With 3D imaging and virtual reality, you can build a detailed plan in your mind before you operate—one that helps you navigate around critical structures, like the carotid arteries, more safely.”

https://drive.google.com/file/d/1AV1MUNJaTR6MQzGtGAaMJ7vUlbHQc3_5/view

DESCRIPTION COPY: Explore a virtually rendered fly-through of the skull, pituitary gland, and tumor used in surgical planning at Mayo Clinic. Watch it here. LINK FOR VIDEO:

 Dr. Bendok likens it to the way pilots practice in flight simulators, or how military personnel have adopted VR and AR technology to plan and train for operations. These tools give surgeons—and the teams that support them—a risk-free environment to rehearse complex cases before ever setting foot in the operating room.

“I’m a big believer that simulation training is absolutely fundamental,” says Dr. Bendok, “because we cannot just learn in the OR—we have to learn outside the OR, where we can create rare scenarios.”

This type of immersive practice is shortening the learning curve for surgeons, allowing them to gain deeper experience and confidence more quickly—especially in high-stakes procedures like pituitary tumor removal.

“If we compare learning curves with this approach versus 10 or 20 years ago, we can accelerate them significantly,” says Dr. Bendok. “Every musician knows that rehearsal leads to better performance—and the same is true for surgery. In the past, rehearsal meant working with cadavers or simply gaining experience case by case. But now, we can be more self-reflective and more individualized in our preparation.”

The potential is enormous. VR- and AR-enhanced surgery doesn’t just make procedures safer—it also enables global collaboration. Surgeons can share rare or complex cases, offering peers around the world the chance to learn from unique anatomies and pathologies. It’s a shift that has the potential to raise the standard of care globally.

As an early adopter of this fast-evolving technology, Dr. Bendok and his team at Mayo Clinic have a bold vision. Their aim is to drive widespread transformation with it—not only in how surgeries are planned and performed, but also in how surgeons train and gain meaningful experience. To make this a reality, Mayo Clinic and their partners are developing online platforms that will eventually give more surgeons access to these virtual simulation tools—regardless of their location. The goal is not just to improve individual outcomes, but to multiply expertise at scale.

“In my career, I may help 10,000 patients through direct surgery,” Dr. Bendok says. “But if we can use this technology to help train others and scale better outcomes worldwide, the impact becomes exponential.”

For people living with the unpredictable and often life-altering symptoms of pituitary conditions like Cushing’s Syndrome, the result can be more than just a safer and successful surgery. It can be a chance to reclaim their well-being and quality of life.

For more information or to request an appointment, please visit Pituitary Tumor Care – Mayo Clinic  

PNA Medical Corner: The PANOMEN-3 grading score

This month the PNA Medical Corner focuses on a study coauthored by longtime PNA member Dr. Maria F

leseriu. The data evaluated more than 400 patients with pituitary tumors using a grade system recently developed by the Pituitary Society.  The results show that the PANOMEN-3 grade system is successful in predicting the long-term outcomes and should be used in clinical practice.

PANOMEN-3 grading score is reliable in predicting pituitary adenoma behavior and prognosis: a single center cohort study

Alessandro Mondin ^1 2, Giulia Bovo ^1 2, Mattia Barbot ^1 2, Maria Fleseriu ³, Luca Denaro ⁴, Carla Scaroni ^1 2, Filippo Ceccato ^5 6

Affiliations Expand

PMID: 40455176   DOI: 10.1007/s12020-025-04292-x   https://pubmed.ncbi.nlm.nih.gov/40455176/

Abstract

Background: Pituitary adenomas (PAs) comprise a heterogeneous group of diseases: a scoring system to guide prognosis and therapy is still missing.

Methods: We assessed a retrospective single-center cohort of 401 patients with PAs followed over the last two decades using a newly developed Pituitary Society grading system, PANOMEN-3.

Results: A high initial grade of the adenoma predicted a worse long-term outcome despite multimodal treatments (grade 3, disease remission OR 0.49, 95%CI [0.27; 0.84], p = 0.01). The grade could predict tumor behavior following surgery: a higher grade at baseline predicted relapses after disease remission (grade 3 vs grade 1/2, p = 0.01) and a higher postoperative grade predicted the need for additional treatments in case of persisting disease (grade 2/3 vs grade 1, p = 0.02). A score downgrade obtained with primary medical predicted the reduction of additional interventions and long-term biochemical control. When considering CD patients, both a lower initial grade (grade 2 vs grade 3, p < 0.01) and preoperative eucortisolism (p = 0.04) reduced recurrence risk. Contrarily to the whole-cohort analysis, grade predicted the surgical outcome in non-functioning pituitary adenomas and in acromegaly.

Conclusion: Our data suggest for the first time that PANOMEN-3 grade system could be useful in everyday clinical practice, aiding physicians in both improving follow-up strategies for patients in remission and in the management of persisting disease for all pituitary adenomas. Especially for CD, a high initial grade could encourage clinicians to institute preoperative medical treatment and to adopt a closer follow-up schedule in cured cases.

Keywords: Cushing’s disease; Grading system; Non-functioning pituitary adenoma; PANOMEN-3; Pituitary adenoma.

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