PNA Spotlight: Dr. Georgios A. Zenonos
This month the PNA Spotlight focuses on Dr. Georgios A. Zenonos, the neurosurgical Associate Director of the Center for Cranial Base Surgery at the University of Pittsburgh Medical Center. He completed medical school at the University of Athens School of Medicine in Greece, where he was valedictorian. He went on to pursue a basic science post-doctoral research fellowship at Harvard Medical School to study the mechanisms of programmed cell death. Dr. Zenonos also completed two formal cranial base fellowships: one at the University of Pittsburgh, focusing on endoscopic endonasal pituitary surgery and minimally invasive approaches, and one at the University of Miami under Drs. Jacques Morcos, and Roberto Heros, focusing on complex open approaches, and cerebrovascular neurosurgery. Dr. Zenonos also has further sub-specialization in stereotactic Gamma-Knife radiosurgery. He completed his internship, residency and chief residency in neurosurgery at the University of Pittsburgh. The PNA posed some questions about his career in pituitary medicine; his answers follow.
What inspired you to choose your career path?
The human brain is the crown jewel of life on earth. Within its mystical weave lies what makes us what we are. Being able to interact with it so directly, while helping people through the most difficult time in their lives felt like an unparalleled privilege. As neurosurgeon, you go to war every day: It’s the patient, their family and you on one side of the ring, and the tumor/disease on the other. The more hostile and complex your opponent, the greater the celebration that follows its defeat. Skull base surgery takes this to the extreme, as the field of neurosurgery where seemingly impossible challenges become daily routine. Nothing really beats the elation of driving the team to victory despite a myriad of adversities - and as a result - the connections that develop with the patients are truly one of a kind.
Having done almost all my training at the University of Pittsburgh, where complex endoscopic endonasal skull base approaches were developed, I was intrigued by how demanding procedures could be performed in a minimally invasive fashion, decreasing morbidity, and the toll on the patient and their families - I was immediately sold! These developments have really revolutionized pituitary surgery, with previously inconceivable feats now becoming routine. Additional training in complex open approaches, cerebrovascular neurosurgery, as well as radiosurgery further expanded the armamentarium of what I consider a comprehensive pituitary and skull base surgeon.
What is the primary focus of your work/research?
My primary focus as a surgeon, involves treatment of skull base tumors, with special emphasis on endoscopic endonasal approaches surrounding the pituitary (including pituitary adenomas, Rathke’s cleft cysts, craniopharyngiomas, chordomas, chrondrosarcomas, esthesioneuroblastomas, meningiomas etc.). In addition, I treat all kinds of skull base and intrinsic brain tumors, as well as cerebrovascular disease either with surgery or radiosurgery. At the Center for Cranial Base surgery, and the Pituitary Center of Excellence, we work with numerous other surgeons, physicians, and other practitioners (including otorhinolaryngologists, neuro-ophthalmologists, neuro-endocrinologists, neuro-radiologists, neuro-oncologists, and radiation oncologists, and physicists) to provide state-of-the-art care for diseases of the pituitary and skull base.
My research interests have multiple facets. Through our anatomy lab, we strive to refine the surgical techniques with which we treat skull base tumors, and tumors surrounding the pituitary gland in particular, minimizing morbidity, while maximizing the effectiveness of every procedure. In addition, we have multiple ongoing clinical studies and trials that allow us to better understand the critical factors influencing outcomes, so we could modify our guidelines and practices and optimize our results. Finally, through basic science, we seek to understand the molecular and genetic underpinnings of the diseases we treat, so as to individualize care, as well as identify actionable targets for novel pharmacotherapies.
What do you consider to be the future of your field?
We really live in an exciting era for medicine, and for skull base surgery in particular. Advances in technology, especially computing power and artificial intelligence (AI), increasingly allow us to effectively process “big data”. Already, there are mountains of accumulated information (clinical, genomic, proteomic, metabolomics and radiomic data, among others), but conclusions have been limited by our traditional ways of interrogating these datasets. Soon, unsupervised AI will allow us to digest this information, likely showing us patterns and radical ideas to which we are currently blind due to our pre-conceptions and the rigidity of our “standards of care”. Individualization of care will be the name of the game, and intelligent algorithms will allow accurate predictions and precision in our interventions, leaving less and less to chance. Guided by these algorithms, advances in imaging technologies, biomarkers as well as robotics and surgical instrumentation, will allow us to see more, know more, and do more, maximizing effectiveness, and minimizing any morbidity.
What should patients know about your field/what deserves more recognition/awareness?
It is important to underscore that the management of pituitary diseases, as well as those diseases closely related to the pituitary (including craniopharyngiomas, chordomas, chrondrosarcomas, esthesioneuroblastomas, meningiomas, etc.) has dramatically changed in the last decade and a half. The unprecedented advancements in surgical technique with expanded endoscopic approaches have revolutionized what is possible, and what is acceptable. For example, incomplete resections of pituitary tumors, or other tumors such as craniopharyngiomas used to be the norm, along with expected deterioration in pituitary function, and with many patients undergoing craniotomies for complex tumors. Nowadays, a craniotomy is almost never required, and complete resections are expected solely through endonasal procedures, even for complex tumors invading the cavernous sinus (previously considered as a no-man’s land), while preservation or improvement of pituitary and visual function is the norm.
Patients and their families should be advocates for themselves by seeking care in Centers of Excellence for skull base and pituitary diseases. Such high-volume centers have concentrated expertise, with dedicated fellowship-trained skull base neurosurgeons and ENT surgeons specializing in endonasal pituitary surgery, as well as an extended team of experts such as neuro-endocrinologists, neuro-radiologists, neuro-ophthalmologists, neuro-oncologists, and radiation oncologists who work in concert to provide comprehensive cutting-edge care.
What would you like to convey about yourself to your patients?
Firstly, I want patients to know that we completely understand how frightening it is to have and to be treated for such tumors. I am deeply appreciative of the trust they put in me and my team to do the right thing, and I feel privileged to be at an institution and be surrounded by other specialists with whom I can offer my patients exactly the care I would want for myself or for any of the members of my family. I treasure my relationships with my patients, and want to be immediately available so I give my cell phone and email to them, encouraging them to contact me anytime with questions or concerns.
I am blessed with a wonderful family - I am married to Rafaella, who is a journalist and keeps me in touch with the world when I am not at the hospital (!), and we have two kids: Andreas (3) and Siena (1). My brother Zenonas is a molecular biologist who is zealously trying to make the world a better place by working on better treatments for malaria. Growing up in a family of doctors, I have come to know firsthand that all the sacrifices we make are all worth it - as there is nothing more fulfilling than helping people through the worst times in their lives. Each relationship with a patient is like a big-little treasure that makes you rich in a way money can’t buy.
Why did you get involved with the PNA and what is the extent of your involvement?
I firmly believe that patients have the right to credible information about their disease process so they can intelligently make decisions in an informed manner. Amongst the
innumerable sources of misinformation on the web, PNA stands as a beacon of patient-centered knowledge and guidance for diseases related to the pituitary. Along with multiple other colleagues on this website and with specialists from around the world, I feel it is our duty to provide educational materials and credible information that will allow patients to advocate for themselves, ask the right questions, and make optimal decisions about their care.
Contact Information for Georgios A. Zenonos, MD