PNA Spotlight: Dr. Gregory Lekovic
This month the PNA Spotlight focuses on Dr. Gregory Lekovic, a member of the PNA and neurosurgeon at the House Clinic in Los Angeles. He is the director of the Gamma Knife Radiosurgery Program at Good Samaritan Hospital and former director of the Spine Trauma program at California Hospital Medical Center. He received his M.D. and Ph.D from the University of Illinois, Chicago and received his J.D. from the Illinois Institute of Technology. He became a non-resident fellow at the Chicago-Kent College of Law and a research fellow at Arizona State University College of Law. He did his fellowships at the Barrow Institute in stereotactic radiosurgery, cerebrovascular/skull base issues and complex spine issues. Dr. Lekovic was kind enough to answer a few questions from the PNA.
1) What is the primary focus of your work/research?
Neurosurgery is a field that combines equal parts knowledge, experience, and technology. My interest is focused on developing and implementing quality of life indices for pituitary patients. This knowledge will hopefully inform us as to what technologies are needed to advance the field further. What is the next break-through that will allow us to reach the next level in efficacy and patient safety? Advances in medical therapy, radiosurgery, imaging, surgical technique, and instrumentation will all be part of the answer. But we must never lose sight of the fact that most pituitary tumors are benign in nature, and take care that our recommended treatment is not more harmful than the underlying disease.
Clinically, my focus is on multi-modality treatment (i.e. surgery, radiosurgery, and medical treatment) of skull base disorders, including both anterior skull base disorders such as pituitary tumors and lateral skull base diseases.
2) What do you consider to be the future of your field?
In my opinion, there has never been a more exciting time in skull base surgery. The expanded use of the surgical endoscope is just the vanguard of transformative techniques and technologies that will revolutionize our approach and treatment of skull base disease. At the same time, advances in endocrinology and physiology are helping us to learn more about the 'normal' pituitary and how to restore its function.
3) What should people know about your field/what deserves more recognition/awareness? (What should people know that they often don't know?)
First, I think ENT physicians are often the 'unsung heroes' in the treatment of pituitary disease. The team concept- where ENT surgeons and neurosurgeons work side by side on every case- is critical to ensuring the best possible outcomes for out patients. ENT doctors and neurosurgeons have different areas of expertise and concern, and working together provides complementary skills and knowledge that benefit the patient. For example, I have learned a lot from my ENT colleagues about preserving functional nasal sinus anatomy, avoiding anosmia, etc. These are huge quality-of-life issues for patients about which neurosurgeons are often under-trained.
Secondly, I think there is a lot of emphasis these days on 'minimally invasive' approaches to the skull base. This is sometimes equated with endoscopic approaches, though in reality sometimes an endoscopic approach can be more destructive to the nose than a 'traditional' microscopic approach. For example, the naso-septal flap, while admittedly a tremendous advance for the treatment of CSF leaks, often causes significant morbidity and may be overused. In the same vein, we need to do a better job communicating to our patients about the enduring need for 'open' approaches- such as craniotomy for tumors with lateral extension or for large meningiomas of the anterior skull base- and we need to continue to train young neurosurgeons in these techniques, as well.
4) Why did you get involved with the PNA and what is the extent of your involvement?
I got involved with PNA after I met Mr. Knutzen at a medical conference where he was a guest speaker. Patients with pituitary disorders and their families are fortunate to have this resource available, and the PNA richly deserves the support it receives from the medical community and patient community alike.