PNA Spotlight: Dr. Manish Aghi
Dr. Manish Aghi is a neurosurgeon and scientist at University of California, San Francisco (UCSF). He completed his MD-PhD degrees through the MSTP program at Harvard Medical School, followed by neurological surgery residency and postdoctoral training at Massachusetts General Hospital. He is currently faculty in the department of neurological surgery and graduate division of biomedical sciences, as well as a principal investigator in the Brain Tumor Research Center at UCSF. As director of the UCSF Center for Minimally Invasive Skull Base Surgery, Dr. Aghi’s neurosurgical practice in the California Center for Pituitary Disorders at UCSF includes the minimally-invasive endoscopic endonasal resection of over 100 pituitary tumors and tumors of the anterior skull base each year. He has authored over 100 articles and 8 book chapters on pituitary tumors and has edited three books on pituitary tumors. Nationwide, in 2016, he directed a multidisciplinary team of specialists who worked with the Congress of Neurological Surgeons (CNS) to produce evidence-based guidelines on the management of nonfunctional pituitary adenomas. These guidelines are currently being updated by a team led by Dr. Aghi. Dr. Aghi also runs an NIH-funded basic science laboratory studying how genetic changes in tumor cells and the cells in their microenvironment contribute to aggressive biology and therapeutic resistance in some brain tumors. The Aghi lab has been awarded multiple research grants from the NIH and private foundations to pursue these studies. Dr. Aghi is also principal investigator of three phase I/II clincial trials using convection-enhanced delivery to deliver chemotherapies directly into brain tumors. Dr. Aghi has served on NIH study sections for reviewing cancer-related grants. From 2018 to 2020, Dr. Aghi was elected to and served as Chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Tumors, which was formed in 1984 and has over 2000 members.
Dr. Aghi was kind enough to answer some questions from the PNA. His answers follow.
What inspired you to choose your career path?
I was drawn to a career as a pituitary neurosurgeon-scientist because it represents the perfect overlap between areas of medicine that I am most passionate about. As a medical student at Harvard, I was always fascinated by the regulatory circuits of endocrinology and how their disturbance by pituitary tumors and pituitary disorders so dramatically affects people’s quality of life, disrupting such basic functions as their vision, day-to-day energy, weight, mood, and reproductive function. I was also drawn to neurosurgery, a field in which technology has advanced so rapidly that we are able to provide minimally invasive access to the center of the skull base for safe resection of pituitary tumors with minimal risk and rapid patient recovery.
What is the primary focus of your work/research?
I am a neurosurgeon-scientist at University of California San Francisco (UCSF) specializing in pituitary tumors as part of the California Center for Pituitary Disorders at UCSF. As a neurosurgeon directing the Center for Minimally Invasive Skull Base Surgery at UCSF, I perform nearly 100 endoscopic endonasal procedures for pituitary tumors each year. I am also a scientist running a lab in the UCSF Diller Cancer Research Building, where I have had NIH and industry funding for over a decade to study the mechanisms by which brain tumors like pituitary tumors form and grow and use these insights to define novel therapies for these tumors.
What do you consider to be the future of your field?
The future of my field will be defined by the significant advances we are making in our understanding of the biology of pituitary tumors. These insights will give rise to meaningful benefits for our patients, including new molecular classifications of pituitary tumors that will help clinicians better predict the natural history and therapeutic responsiveness of these tumors and targeted therapies that will offer non-surgical options for some patients.
What should patients know about your field/what deserves more recognition/awareness?
Patients need to know how important multi-disciplinary care is for pituitary disorders. During a visit to our center, patients will usually be seen not only by me, but by an endocrinologist and other pertinent specialists relevant to their condition such as ENT, radiation oncology, or ophthalmology. This ensures that they are receiving the best possible care with decision making made by the consensus opinions of multiple specialists following evidence-based guidelines.
What would you like to convey about yourself to your patients?
I would like to convey to my patients how committed I am to their well-being. When I am not seeing them in clinic, I am constantly reviewing their imaging and hitting refresh on the electronic medical record to get their lab results as soon as they become available, sharing their hopes for durable biochemical remission and preservation of hormonal function. And while I am a neurosurgeon, I am a doctor first and recognize that surgery is a tool that must be reserved for cases that will benefit from surgery, as many incidentally found small tumors have a benign natural history that will be unlikely to harm the patient during their lifetime, making observation through serial imaging the recommended course of action over surgery for these particular patients.
Why did you get involved with the PNA and what is the extent of your involvement?
I joined the PNA over a decade ago because the PNA has been very impactful in making the small number of high-volume pituitary specialists throughout the country available as an educational resource for patients, no matter where the patients are located. I have enjoyed meeting patients from all over the U.S. and the world after numerous PNA webinars and answering their questions, as it allows me to help patients from beyond my geographical area.