Juan C. Fernandez-Miranda, MD

Associate Professor
Associate Director, Center for Skull Base Surgery
Director, Surgical Neuroanatomy Lab
Director, Fiber Tractography (HDFT) Lab


Juan C. Fernandez Miranda

Contact

412-647-6778

Biography

Juan C. Fernandez-Miranda, MD, is associate professor of neurological surgery, associate director of the Center for Cranial Base Surgery, and director of the Surgical Neuroanatomy Lab and Fiber Tractography Lab at the University of Pittsburgh School of Medicine. He joined the faculty at the University of Pittsburgh Department of Neurological Surgery on July 1, 2008 to complete a two-year clinical fellowship in open and minimally invasive skull base, pituitary, and brain surgery with Amin Kassam, MD, Paul Gardner, MD, and Daniel Prevedello, MD.

Prior to joining the faculty at University of Pittsburgh, Dr. Fernandez-Miranda completed a clinical fellowship in cerebrovascular surgery at the University of Virginia—under the direction of Neal F. Kassell, MD—and a two-year research fellowship in microsurgical neuroanatomy at the University of Florida—under the mentoring of Albert L. Rhoton, Jr., MD.

Dr. Fernandez-Miranda, received his medical degree from the Complutense University of Madrid (Spain) and completed his neurological surgery residency at “La Paz” University Hospital of Madrid. Upon completion of his residency, he was awarded the Sanitas Prize 2006 to the best medical postgraduate trainee in Spain.

Dr. Fernandez-Miranda’s clinical focus is endoscopic endonasal skull base and pituitary surgery, open skull base surgery, and complex brain surgery. His research interests lie in the study of surgical neuroanatomy and brain connectivity, and the application of innovative techniques into the operating room. He has published more than 140 scientific peer-review papers, and he has lectured extensively at national and international scientific meetings and professional courses.

The Surgical Neuroanatomy Lab that he directs has a dual educational and research role aiming to improve surgical techniques and outcomes by mastering knowledge of relevant surgical neuroanatomy. Many national and international physicians have conducted training and research at the Surgical Neuroanatomy Lab. The lab has three main research areas: microsurgical neuroanatomy, endoscopic skull base anatomy, and white matter anatomy. Dr. Fernandez-Miranda has major publications and awards on each of these areas, and his research work has contributed significantly to the development and expansion of endoscopic skull base surgery.

The Fiber Tractography Lab, funded with a major NIH award, is focused on the application of advanced fiber mapping techniques—High-Definition Fiber Tractography (HDFT)—for presurgical planning and intraoperative navigation to facilitate brain function preservation and improve resection rates in patients with complex brain lesions. Dr. Fernandez-Miranda’s work is also centered on studying the structure and connectivity of the fiber tracts forming the “normal” human brain, and their structural alteration in patients with brain tumors, vascular lesions, stroke, and neurodegenerative diseases.

In addition to his clinical and research activities, Dr. Fernandez-Miranda is greatly devoted to teaching and education of 3D surgical neuroanatomy and techniques at local, national, and international venues.

Specialized Areas of Interest

Endoscopic pituitary surgery; minimally invasive endoscopic skull base and brain surgery; open skull base surgery; brain tumors. Research focuses on surgical neuroanatomy (micro-surgical neuroanatomy, endoscopic skull base anatomy, and white matter anatomy), advanced brain imaging techniques, and brain connectivity.

Board Certifications

Spanish Society of Neurosurgery, Spanish Ministry of Science and Education
European Association of Neurosurgical Societies, European Board of Neurosurgery

Hospital Privileges

Children's Hospital of Pittsburgh of UPMC
UPMC Mercy
UPMC Presbyterian

Professional Organization Membership

American Association of Neurological Surgeon
Cajal Club
Congress of Neurological Surgeons 
European Association of Neurosurgical Societies
German Skull Base Society
International Head and Neck Scientific Group 
Joint Section on Tumors – AANS & CNS
North American Skull Base Society 
Spanish Society of Neurosurgery

Education & Training

MD, Complutense University of Madrid, 2000
Residency, Neurosurgery, “La Paz” University Hospital of Madrid, 2006
Fellowship, Microsurgical Neuroanatomy, University of Florida, 2007
Fellowship, Cerebrovascular Surgery, University of Virginia, 2008
Fellowship, Endoscopic Endonasal/Skull Base Surgery, University of Pittsburgh, 2010

Honors & Awards

  • Pedro Mata Award of the Neurosurgical Society of Madrid to the Best Neurosurgical Research for the work “Three-Dimensional Microsurgical Anatomy and Tractography of the White Matter of the Human Brain.”
  • Sanitas Prize 2006 to the Best Medical Postgraduate Trainee in Spain.
  • Recipient of the Synthes CMF (Cranio-Maxillofacial) Anatomical Fellowship.
  • Aesculap EANS (European Association of Neurosurgical Societies) Research Prize for the work “Three-Dimensional Structure of the White Matter of the Human Brain.”
  • European Skull Base Fellowship Award, 2009.
  • VII National Research Award, Barclays Foundation, 2009
  • Best Doctors, Pittsburgh Magazine, 2013-2016
  • NIH-R01 Award (R01DC013803-01A1), 2015-2020

Selected Publications

Wang WH, Abhinav K, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC. Endoscopic endonasal transclival transcondylar approach for foramen magnum meningiomas: surgical anatomy and technical note. Neurosurgery [Epub ahead of print], 2015.

Fernández-Miranda JC, Wang Y, Pathak S, Stefaneau L, Verstynen T, Yeh FC. Asymmetry, connectivity, and segmentation of the arcuate fascicle in the human brain. Brain Struct Funct 220(3):1665-80, 2015.

Abhinav K, Yeh FC, Mansouri A, Zadeh G, Fernandez-Miranda JC. High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery. Neuro Oncol 17(9):1199-209, 2015.

Abhinav K, Acosta Y, Wang WH, Bonilla LR, Koutourousiou M, Wang E, Snyderman C, Gardner P, Fernandez-Miranda JC. Endoscopic endonasal approach to the optic canal: Anatomic considerations and surgical relevance. Neurosurgery 11 Suppl 3:431-46, 2015.

Fernandez-Miranda JC, Gardner PA, Rastelli MM Jr, Peris-Celda M, Koutourousiou M, Peace D, Snyderman CH, Rhoton AL Jr. Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. J Neurosurg 121(1):91-9, 2014.

Fernandez-Miranda JC, Pathak S, Engh J, Jarbo K, Verstynen T, Yeh F, Mintz A, Boada F, Schneider W, Friedlander R. High-Definition Fiber Tractography of the Human Brain: Neuroanatomical Validation and Neurosurgical Applications. Neurosurgery 71(2):430-53, 2012.

Fernandez-Miranda JC, Morera VA, Snyderman CH, Gardner P. Endoscopic endonasal transclival approach to the jugular tubercle. Neurosurgery 71(1 Suppl Operative):ONS146-59., 2012.

Fernandez-Miranda JC, Tormenti M, Latorre F, Gardner P, Snyderman C. Endoscopic endonasal middle clinoidectomy: anatomical, radiological, and technical note. Neurosurgery 71[ONS Suppl 2]:ons233-ons239, 2012

Fernandez-Miranda JC, de Oliveira E, Rubino P, Wen HT, Rhoton AL Jr: Microvascular anatomy of the medial temporal lobe: Part 1: its application to arteriovenous malformation surgery. Neurosurgery 67(3 Suppl Operative):237-76, 2010.

Fernandez-Miranda JC, Rhoton AL Jr, Alvarez-Linera J, Kakizawa Y, Choi C, de Oliveira E: Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery 62(6 Suppl 3):989-1028, 2008.

A complete list of Dr. Fernandez-Miranda's publications can be reviewed through the National Library of Medicine's publication database.

Research Activities

• Surgical Neuroanatomy Lab:

1) Endoscopic Endonasal Transclival Transcondylar Approach for Foramen Magnum Meningiomas: Surgical Anatomy and Technical Note.

Dr. Fernandez-Miranda’s lab investigated the surgical anatomy and technical nuances for endonasally increasing the surgical corridor at the FM region both laterally and inferiorly. Unique to the report, the lab’s researchers quantified the amount of required medial condyle resection to obtain exposure of the lateral aspects of the FM.

2) Endoscopic Endonasal Interdural Middle Fossa approach to the Maxillary Nerve: Anatomical Considerations and Surgical Relevance.

The Surgical Anatomy Lab delineated the anatomy of the V2 and its specific segments with respect to the endonasal landmarks. Here, lab researchers presented the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors.

3) Cavernous Sinus Compartments from the Endoscopic Endonasal Approach: Anatomical Considerations and Surgical Relevance.

In this study, the Surgical Anatomy Lab aims to develop a surgical anatomy based classification of the CS and to establish its utility for preoperative surgical planning and intraoperative guidance.

4) Live Cadaver Model for Internal Carotid Artery Injury Simulation in Endoscopic Endonasal Skull Base Surgery.

The live cadaveric model presented here provides real life experience of major vessel injury in laboratory settings. This model could significantly improve current training for management of intraoperative endoscopic endonasal carotid rupture, and can potentially be used for developing novel methods to treat vascular problems, including vessel reconstruction techniques.

• Fiber Tractography Lab:

1) Visualization of Cranial Nerves Using High-Definition Fiber Tractography.

Using high-angular-resolution fiber tracking and atlas-based fiber tracking, lab researchers were able to identify all CNs in unprecedented detail. This implies its potential in localization of CNs during surgical planning.

2) Human Connectome-Based Tractographic Atlas of the Brainstem Connections and Surgical Approaches.

The Fiber Tractography Lab acquired the tractography of the major brainstem pathways and validated them with histological analysis. The pathways included the cerebellar peduncles, corticospinal tract, corticopontine tracts, medial lemniscus, lateral lemniscus, spinothalamic tract, rubrospinal tract, central tegmental tract, medial longitudinal fasciculus, and dorsal longitudinal fasciculus. Then, the reconstructed 3-dimensional brainstem structure was sectioned at the level of classic surgical approaches, namely supracollicular, infracollicular, lateral mesencephalic, perioculomotor, peritrigeminal, anterolateral (to the medulla), and retro-olivary approaches.

3) The Nondecussating Pathway of the Dentatorubrothalamic Tract in Humans: Human Connectome-Based Tractographic Study and Microdissection Validation.

Lab researchers applied advanced deterministic fiber tractography to a template of 488 subjects from the Human Connectome Project. The connections of the dentate nucleus with the red nucleus and thalamus are bilateral, not ipsilateral only.

4) The Controversial Existence of the Human Superior Fronto-Occipital Fasciculus (SFOF): Connectome-Based Tractographic Study with Microdissection Validation.

The imaging results showed that previous reconstructions of the SFOF were generated by two false continuations, namely between superior thalamic peduncle (STP) and stria terminalis (ST), and ST and posterior thalamic peduncle. The anatomical microdissection confirmed this finding. No other fiber tracts in the previously described location of the SFOF were identified. Hence, data suggest that the SFOF does not exist in the human brain.

Media Appearances

A better road map for neurosurgeons
May 5, 2013
philly.com

UPMC On Topic Videos

Pituitary Adenoma Treatment
Dr. Fernandez-Miranda discusses treatment options for pituitary adenomas at UPMC.

Meningioma Treatment
Dr. Fernandez-Miranda discusses treatment options for meningioma at UPMC.

Abordaje Endonasal Endoscópico
Dr. Fernandez-Miranda discute el Abordaje Endonasal Endoscópico.

Tumores de Hipofisis
Dr. Fernandez-Miranda discute tratamiento para tumores de hipofisis