PNA Spotlight: Dr. Philip Theodosopoulos

TheodosopoulosThis month the PNA Spotlight focuses on Dr. Philip Theodosopoulos, director of the Skull Base Tumor Program and vice chair of neurological surgery at the University of California San Francisco. Before joining UCSF, he served as director of skull base surgery at the University of Cincinnati for 10 years. He earned his undergraduate degree from MIT and graduated from the Stanford University School of Medicine in 1996. He did a residency in neurosurgery at UCSF Medical Center and then a fellowship in cerebrovascular and skull base surgery at Brigham and Women’s Hospital, an affiliate of Harvard Medical School. He is certified in neurological surgery by the American Board of Neurological Surgery. He specializes in skull base lesions, particularly malignancies and acoustic neuromas. He performs endoscopic pituitary surgery. The PNA posed some questions to Dr. Theodosopoulos; his answers are included below.

What inspired you to pursue a career in pituitary medicine?

Early on in life I was inspired by the unfulfilled dream of my mother, who aspired to become a doctor. During my formative years at MIT, I worked in the Brain and Cognitive Sciences department doing research on proprioception and was inspired to go into a medical field which studies the brain. During medical school I worked in Jack McMahan’s lab at Stanford, where the acetylcholine receptor was discovered, and my research with him solidified my interest in neurosurgery as a field.

What is your specialty?

During my almost two decades of practice now (following my training) I have focused on the study of benign or slow-growing tumors. My interest has been two-fold: new treatment methods for tough-to-access tumors and a better understanding of what makes otherwise “benign” tumors recur and behave aggressively. My lab was the first one to describe a number of endoscopic and minimally invasive access corridors to the skull base, including the cavernous sinus and infra-temporal fossa. Recent work in collaboration with Dr. Raleigh from the department of Radiation Oncology at UCSF has shed light on the epigenetic determinants of aggressive behavior of tumors. What we have found relates to DNA methylation patterns that seem to be responsible for turning a slow-growing skull base tumor into an aggressive phenotype, which then causes recurrence and the need for intensive treatment.

What do you consider to be the future of your field?

The future of our field in pituitary and overall skull base tumor treatment is very exciting. Not only are the technologies constantly improving, but there is a lot of research in finally trying to understand the molecular behavior of such tumors. The recent introduction of 3D endoscopy, the continual innovation in image clarity and resolution and the improved instrumentation make it safer and, in certain cases, possible for the first time to surgically treat tumors that had been thought of as inoperable up until now. Then you add to that the refinements of radiosurgery with better planning software and submillimetrically accurate targeting of lesions. So we now have a lot more tools in our armamentarium to control these tumors at recurrence and following multiple treatments. Finally, we have made major strides in the molecular understanding of how certain genes that responsible for more aggressive behavior are turned on in a tumor. This sheds light into the possible novel pathways of treatment with small molecule inhibitors and other medical therapies.

Our program here at UCSF prides itself on being at the forefront of treatment of all brain tumors. and especially pituitary tumors. Since the days when Charlie Wilson brought the transsphenoidal approaches to the forefront of neurosurgery, we have remained one of the most important and busiest centers in the country committed to treating pituitary tumors. Technological innovation has remained steady ever since . Now, more than forty years later, we are using space-age technology with ultra-high definition endoscopes, intraoperative imaging and submillimetrically accurate navigation tools to be as safe and effective as we can be in resecting such tumors.

We have pioneered many of the new approaches into the areas of the skull base that such tumors invade and continue to innovate with technology daily. When it comes to treatment with radiosurgery of any residual or recurrent tumors, we have not only the most up to date Gamma Knife platform but also the Cyberknife and several other linear accelerator modalities available, spanning the entire gamut of radiation treatment possible for such tumors. Finally, and possibly most importantly, our center is led by a pituitary endocrinologist, Dr. Lewis Blevins, who has unparalleled experience in the treatment of pituitary disease. Here at UCSF we have use a team approach – with endocrinologists, ophthalmologists, otolaryngologists, radiation oncologists and neurosurgeons who tailor personalized treatments for each individual patient. We host seminars and conferences for patients with pituitary disease and work to be an effective partner for the patient from diagnosis, through treatment and follow up.

Why do you support the PNA and what is the extent of your involvement?

The PNA has been a pillar in supporting patients with pituitary disease for many decades and our program is proud to support it and be associated with it.

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