“What was born here is reborn today.”
PITTSBURGH, PA (February 17, 2026) — A University of Pittsburgh and UPMC team has performed the first endoscopic endonasal approach (EEA) to the skull base for resection of a pituitary tumor using mixed reality (MR) integrated into the operative workflow. The procedure was performed at UPMC Presbyterian Hospital by George Zenonos, MD, Associate Professor of Neurological Surgery and Neurosurgical Director of Center for Cranial Base Surgery and Pituitary Center for Excellence, and Garrett Choby, MD, Associate Professor of Otolaryngology-Head & Neck Surgery and Neurological Surgery. The milestone reflects a multi-year effort to translate mixed reality from the bench to bedside through collaboration between Pitt School of Medicine, the Pitt School of Computing and Information (SCI), and UPMC Department of Neurosurgery.
The MR capability used in this case was developed through the leadership of Edward G. Andrews, MD, Assistant Professor of Neurological Surgery in Pitt’s School of Medicine, and Jacob Biehl, PhD, Associate Professor of Computer Science in Pitt SCI, who co-lead Pitt’s Surreality Lab. Their students, Griffin Hurt, B.Phil, and Ethan Crosby are spearheading the implementation of the streaming platform under Dr. Biehl’s and Dr. Andrews’ mentorship, The lab links neurosurgical expertise with computing and human-centered systems research to support how expert teams access and interpret patient-specific imaging and anatomy during complex procedures. The lab collaborated extensively with and benefited from the expert guidance of Paul Gardner, MD, Professor of Neurological Surgery at NYU and Director of NYU’s Pituitary Center for Excellence and Cranial Base Center, and world-renowned thought leader in skull base surgery.
This first also fits within Pittsburgh’s history in skull base surgery. Endoscopic skull base techniques were pioneered and advanced at Pitt/UPMC through decades of clinical practice, training, and research. In that context, the team’s tagline is intended to be literal, connecting an established surgical legacy to a new intraoperative workflow capability.
ABOUT THE PROCEDURE: EEA PITUITARY SURGERY
Pituitary tumors sit at the skull base near critical structures including nerves associated with vision, major blood vessels, and within the pituitary gland itself, which has critical hormonal function. The endoscopic endonasal approach (EEA) reaches the tumor through the nasal passages using an endoscope, a camera adapted for this surgery, along with specialized instruments, avoiding a traditional large cranial opening. Because of its minimally invasive nature, EEA is technically demanding: the target is deep, the corridor is narrow, and surrounding anatomy is of high consequence.
The case involved removal of a tumor situated in the pituitary gland that was releasing excessive hormone into the patient’s body. This had an extensive impact on the patient’s quality of life. Dr. Zenonos and his team had to use a drill to first remove the bony covering at the base of the skull protecting the pituitary gland. There was concern for early invasion of an adjacent venous structure, thus one of the main arteries providing blood to the brain, the internal carotid artery, was also exposed. The leathery covering around the space in which the pituitary is situated, or dura, was then opened and the tumor was delicately removed while avoiding injury to normal parts of the gland. Portions of the dura had to be removed that were adjacent to a big draining vein nearby as well to test for invasion. The surgery occurred without complication. The patient is recovering well with evidence of full tumor removal and otherwise normal health.
WHAT MIXED REALITY CONTRIBUTED
MR was used to improve how information was placed and accessed during the operation. Instead of relying only on fixed displays outside the Dr. Zenonos’ immediate working area, MR allowed key patient-specific information to be brought into his working space in a timely, task-relevant way. The goal was not more information delivered, but better information delivery—reducing the need for attention shifts, minimizing context switching, and lowering cognitive load during critical steps in the surgery. The use of MR was not to replace surgical judgment or established technique, but to support Dr. Zenonos’ decision-making by making essential information easier to reference, at the moment it was needed, without disrupting operative workflow.
MR is a burgeoning technology in healthcare. This case represents a huge leap in this technology’s potential to democratize surgical care through low-cost, digitized workflow solutions. It has relevance not only in neurosurgery, but all surgical disciplines, regardless of environment whether urban or rural, of worlds whether developed or developing.