A journey begins

Ms. Orlando’s cancer journey began early in 2021 with the discovery of a malignancy in her kidney. It was caused by a rare genetic disorder. Tatum Tarin, MD, removed the kidney — but a couple of months later, during follow-up treatment at UPMC Hillman Cancer Center, including immunotherapy infusions, Ms. Orlando developed a severe headache and nausea. Her oncologist, Leonard Appleman, MD, PhD, suggested she have an MRI of her brain. That revealed a tumor — unrelated to the kidney cancer.

“I had known for years that there was a small spot in my brain,” Ms. Orlando says. “It was discovered incidentally in 2011. At that time, nobody thought it was anything. It caused no symptoms. Well, the brain MRI in June of 2021 showed that it had grown about three times its 2011 size. 

“And that’s what led me to my wonderful neurosurgeon, Dr. Pascal Zinn.” 

Both a physician and a research scientist, Pascal O. Zinn, MD, PhD, joined UPMC Shadyside and Hillman Cancer Center in 2019 from MD Anderson Cancer Center. He is director of the adult neurosurgical oncology program at the University of Pittsburgh and, at Hillman, is the principal investigator of a molecular biology laboratory studying approaches in personalized tumor treatments and patient care. Also committed to teaching, Dr. Zinn was proud to be named best faculty teacher by the University of Pittsburgh’s neurological surgery residents in 2022. 

To Nicole Orlando, he is simply “the top of the top — calming, reassuring, patient, and so kind. He spent a lot of time with my husband and me. His goal is to give every patient the very best and most personalized comprehensive treatment.”

Operating in augmented reality

In addition to his skill and experience, Dr. Zinn had a further advantage in planning and carrying out Ms. Orlando’s surgery at UPMC Shadyside: Brainlab. This highly advanced technology is an integrated software and hardware system that “revolutionizes how we combine preoperative imaging information with surgery,” Dr. Zinn states.

“The limitation of doing any surgery is vision,” explains Dr. Zinn, who, incidentally, earned honors in marksmanship as a member of the Swiss Army Special Forces. “But this system allows us to map the tiny nerve fiber networks in each individual’s brain.

“This ‘map,’ with the nerve fiber networks highlighted in color, is then projected in real time into a large microscope that hangs from the ceiling over the operating site,” Dr. Zinn continues. “That is what I look through while I am operating. It has perfect light and magnification and different filters to highlight the tumor cells. The system’s camera keeps me continually updated with every move. In this ‘augmented reality,’ I can pinpoint the tumor, actually see the tumor cells better to remove them, and minimize nearby damage. 

“It makes brain surgery safer, more precise, and more efficient.” 

Nicole Orlando was not aware of the amazing tech-nology at Dr. Zinn’s disposal, but she especially appreciated his concentration on her safety. 

“As an occupational therapist, I have worked with many post-surgery patients,” she says. “He knew how concerned I was about any possible post-op difficulties, and during my surgery, he saw that it just was not safe to get 100 percent of the tumor without affecting my ability to speak or move. He got at least 90 percent, if not a little bit more. As much as he could as safely as he could. And I know myself, my husband, and my family really appreciated that, that he kept me safe.”

As Dr. Zinn says, “What I treat are sometimes difficult problems to solve. Cancer of the brain or spinal cord has the potential to permanently affect a person. The brain is who we are, right? That’s why it’s a difficult job sometimes. 

“But it’s also immensely rewarding, and a true privilege. I tell the patients, ‘What a privilege that you let me operate on your brain, this miracle organ.’”

The commitment to moving forward

The investment in Brainlab highlights UPMC Shadyside’s commitment to growing state-of-the-art neurosurgery —
as does the 2022 arrival of neurosurgeon Kalil G. Abdullah, MD, MSc, who specializes in the treatment of adult brain tumors. An NIH-funded investigator who was recruited to Pittsburgh from the University of Texas, Dr. Abdullah is the director of Translational Neuro-Oncology at UPMC Hillman Cancer Center and runs a laboratory that aims to develop new drug and treatment targets for brain cancers. He has published more than 100 research articles, and his work is focused on bringing promising new brain tumor drugs to clinical trial.

“UPMC Hillman is a really dynamic place,” Dr. Abdullah states. “Both the neurosurgery program here and the cancer center are phenomenal, and they are among the best in the country. When I saw the direction of the cancer center and its mission, I knew I wanted to be a part of it. It is a bonus that my family and I have found Pittsburgh to be a wonderful city to live in.

“My partner Pascal Zinn really championed this Brainlab technology,” Dr. Abdullah continues. “Knowing that these types of investments in our brain tumor program were being made signaled to me that the commitment to moving forward was real. It’s really a team effort.”

In order to treat someone with a brain tumor, Dr. Abdullah says, “the technology that we use has to be absolutely cutting edge. The Brainlab navigation system is basically an advanced GPS for the brain. Imagine driving in your car and trying to locate exactly where you’re going. For brain tumor surgery, you need an incredibly precise picture. 

“So, before surgery, patients have a very fine resolution MRI that uses something called fiber tracking to map intricate regions of the brain. We can actually look at where your speech is and where your movements come from. We then design surgical plans before we start operating to help us really navigate in the best way possible and
get the most amount of tumor out in the safest way we can.”

Shadyside is unique

“Fiber-tracking technology is unique to sophisticated cancer centers, of which there aren’t that many in the country, one or two per state at the most,” adds Dr. Abdullah.

“Shadyside has world-class cancer care in what feels like a community setting,” he says. “We really treat people as if they are friends and family — that’s the kind of relationship we are trying to build with our patients. It is amazing to have a culture like that at a cancer center that is among the best in the world. The volume of patients that we see and the complexity of cases that we see are astounding, and our experts are able to provide truly advanced and cutting-edge care to patients. It’s something to be really proud of.”

Dr. Abdullah is optimistic about the future. “Even as recently as 10 years ago, if you had a brain tumor that came from a cancer in another part of your body, the prognosis was very poor. Now, I have patients who are doing wonderfully many years out from their diagnosis. It’s wonderful to be a part of this progress.”

The world-class care she has received gives Nicole Orlando similar hopes for the future. (Her post-op treatment team included radiation oncologist Zaid Ali Siddiqui, MD, and neuro-oncologist Jeremy Rich, MD, for chemotherapy.) “Going through the radiation/chemo has also been an important part of my journey,” she says. “I’m not going to lie, this has been rough sometimes. But when you have a great medical team of doctors, nurses, and other health care workers all coming together to help you, and when you have the best family and friends behind you, that makes it so much easier.

“And if telling about my journey can encourage others in a similar situation, that gives me joy.” 

For both Dr. Pascal Zinn and Dr. Kalil Abdullah, the interplay between the operating room and the research laboratory is paramount.

To learn more about Dr. Abdullah’s research at the Translational Neuro-Oncology Laboratory, please visit https://www.neurosurgery.pitt.edu/research/labs/translational-neuro-oncology.

To learn more about Dr. Zinn’s research on patient-centered care for brain and spinal tumors, please visit https://www.neurosurgery.pitt.edu/research/labs/molecular-tumor-precision. A portion of Dr. Zinn’s research is funded by the Shadyside Hospital Foundation.