Epilepsy and shunt surgeries offer the neuropathologist a unique glimpse into the living brain, says Professor Tuomas Rauramaa.
In March, the University of Eastern Finland appointed Rauramaa by invitation as Professor of Pathology, with a special focus on neuropathology. Currently, there are only two professors of neuropathology in Finland, with the other being at the University of Helsinki. Rauramaa also serves as Chief Physician at Kuopio University Hospital (KYS).
Pathology is an unfamiliar field to many, and it is often associated with autopsies. While pathologist do also perform these, their primary focus is on diagnosing cell and tissue samples from living patients. “As a medical discipline, pathology examines structural and functional changes in various diseases, as well as their causes and development. Neuropathology, on the other hand, focuses on neuromuscular diseases.”
Mechanisms that degenerate and protect the brain
According to Rauramaa, neuropathologists often operate at the intersection of patient care and scientific research. Rauramaa’s own research has focused particularly on degenerative brain diseases and epilepsy, utilising surgical biopsies from patients for both diagnostic and research purposes.
“For example, the shunt surgeries used to treat NPH-related memory disorders offer a unique glimpse into the living brain. The surgery involves taking a small brain tissue sample, which can be used for both diagnostic purposes and for investigating, through various methods, the disease mechanisms that contribute to brain degeneration. The collaboration between the hospital and basic research on campus has worked very well.”
These samples are also being used in an ongoing project that investigates the impact mechanisms of newly discovered gene alterations that shield people from Alzheimer's disease.
Brain tissue samples are also collected during epilepsy surgeries for a multitude of research purposes. For example, Rauramaa has been involved in a collaborative project where an artificial intelligence (AI) system was trained, based on digitised microscopic images of tissue samples, to identify different subtypes of a developmental disorder that causes epilepsy.
“AI models can identify changes that cannot be seen by the human eye, so they will undoubtedly change the work of pathologists. In fact, AI has already become an ordinary tool in research.”
In addition to neuropathology, Rauramaa studies other areas, such as lung diseases. A recently published study showed that lung cancer prognoses can be enhanced by adding a liquid biopsy – where extracellular DNA from a tumour is isolated from the patient’s blood sample – to the tumour’s histopathological examination.
Increased efficiency through digital pathology
Next year, KYS intends to adopt a digital pathology approach. In the future, almost all samples will be scanned into digital images that can be viewed on a computer monitor. This will facilitate consultations between physicians, make archiving samples easier, and enable the use of AI applications.
According to Rauramaa, it is difficult to predict how the field will develop in the future: “Although many things have changed, pathology's core approach remains much the same as it was in the 19th century – the gold standard in diagnostics is structural changes that can be seen under a microscope.”
“When I began specialising in 2007, we primarily relied on microscopes. Since then, a major change was the introduction of molecular pathology as part of our daily diagnostic routine.
Molecular pathology includes various approaches, such as genetic analyses of cancer samples, which make it possible to choose a treatment approach according to the tumour’s specific gene mutation.
The field of pathology is closely connected to biobanks. The samples of patients who have signed the KYS biobank consent form are stored in the Biobank of Eastern Finland, where they are used extensively for scientific research. “Biobank research relies on the expertise of pathologists, and we can also provide specific samples upon request,” adds Rauramaa, who is part of the biobank’s scientific steering group.
Pathology is teamwork
According to Rauramaa, the future of pathology as a medical specialty currently looks bright, as there are plenty of people specialising in the field. However, there is some regional variation in Finland as a whole. After a physician has specialised in pathology, they can attain additional training in neuropathology or paediatric pathology.
Basic studies in medicine and dentistry include extensive courses on pathology. “We are actively developing our teaching approach to inspire new generations to enter the field,” Rauramaa says.
According to Rauramaa, the field is suited to those interested in the nature of diseases and who have the ability and patience to understand broader questions in a visual and conceptual sense. In addition to examining samples, making an accurate diagnosis may require hours of information retrieval and consultations with other experts. “It’s not unusual for a pathologist to ask their colleagues, both in Finland and abroad, for their opinions.”
“It also takes the work of several people before a sample is ready for a pathologist’s examination. In other words, pathology is very much a team effort!”
Tuomas Rauramaa
Professor of Pathology, with a special focus on neuropathology, at the University of Eastern Finland, 1 March 2026–
- Licentiate of Medicine, University of Tartu 2006
- Specialist Physician in Pathology, University of Eastern Finland 2012
- Further training in neuropathology, University of Eastern Finland 2015
- MD, University of Eastern Finland 2016
- Special Competence in Medical Education, Finnish Medical Association 2019
- Docent of Pathology, especially in neuropathology, University of Eastern Finland 2020
Key positions
- Chief Physician (part-time), KYS, Department of Clinical Pathology 2025–
- Professor of Neuropathology, University of Eastern Finland 2025–2026
- Deputy Chief Physician (part-time), KYS, Department of Clinical Pathology 2020–2025
- Duties of a specialist physician, university lecturer, and clinical teacher, KYS and the University of Eastern Finland 2012–2020
- Assistant and junior researcher, University of Kuopio and Eastern Finland 2008–2012
- Specialising physician, KYS and Central Hospital of Central Finland 2007–2012
