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Arnold Menezes: Five decades of excellence at Iowa
Neurosurgeon recognized worldwide as pioneer in treating skull-base abnormalities
What defines a legend?
While the term is often applied to individuals who achieve even a modest level of success, a true legend transcends their accomplishments and awards. They challenge the status quo, upend preconceived notions and stereotypes, and change lives through their ideas and their actions.
Arnold Menezes, MBBS, is a legend.
In 2024, the world-renowned neurosurgeon and clinician marks 50 years of service at the University of Iowa. Since completing fellowship training in pediatric neurosurgery at Iowa and joining the university’s medical faculty in 1974, Menezes has transformed understanding and surgical approaches of the craniocervical junction—the area where the skull meets the spine.
Within our specialty, everyone—and I mean neurosurgeons around the world—views Arnold as the premier guy in this particular area of research and treatment. That’s why so many colleagues from all over the world refer their patients to Iowa.
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Matthew Howard, MD, professor and chair of the UI Department of Neurosurgery
Menezes has treated thousands of patients throughout his career from across America and around the world. Since the 1970s, he has designed neurosurgical procedures at the base of the skull, and he’s built one of the world’s largest databases that tracks disorders of the craniocervical region.
He has authored hundreds of peer-reviewed publications, written foundational textbooks on craniovertebral abnormalities, and delivered well over 800 scientific presentations throughout the U.S. and abroad. He was involved in developing some of the first practical courses in spine surgery, and he was instrumental in establishing spinal neurosurgery programs in Africa, Asia, Europe, and South America.
Through it all, he has trained, mentored, and influenced hundreds of resident physicians, colleagues, and staff—serving as role model for excellence and enthusiasm in neurosurgery and academic medicine.
“Within our specialty, everyone—and I mean neurosurgeons around the world—views Arnold as the premier guy in this particular area of research and treatment,” says Matthew Howard, MD, professor and chair of the UI Department of Neurosurgery. “That’s why so many colleagues from all over the world refer their patients to Iowa. He was able to identify and correct these problems at the juncture of the skull and spine. He’d figure out how each patient should be treated, then he’d spectacularly attend to every detail in the O.R. and in clinic. Every detail, he was on top of it.”
Overcoming challenges—and finding an opportunity at Iowa
Born in Mumbai, India, Menezes comes from a long line of medical professionals. His father was a physician, and his grandfather and great-grandfather were surgeons.
As a student at the Topiwala National Medical College at Bombay University in the mid to late 1960s, Menezes recognized that treatments for brain tumors in children were largely unsuccessful.
“We are talking before the time of CT and MRI,” Menezes says. “The overall results in the care of these patients were awful.”
With advanced training, Menezes believed he could change this. He looked to the United States as the place of opportunity for himself and his wife, Meenal, who was also a physician.
But for India-born doctors interested in medical residencies in the U.S. at the time, such opportunities were not easily attainable.
“Discrimination,” Menezes explains. “Back in medical school, I stood first in anatomy, first in general surgery, first in internal medicine. But it didn’t matter. Many places were not interested in someone like me.”
Menezes did secure a medical internship at a community hospital in South Chicago, which “taught me what not to do,” he says. The experience also underscored for Menezes the importance of finding a major academic medical center where he and his wife could both receive residency training. They each were accepted separately to highly respected institutions, but not together.
Other institutions were less than welcoming.
“I did apply to a number of academic centers,” Menezes says, “and the general response I got from some of these was, ‘We have better people than you to choose from.’”
Menezes has kept some of the rejection letters, and he’s shared several with Howard.
“Just terrible stuff. Letters saying they’d never take a doctor from India because they’re not competent and they’re not trustworthy. And worse,” Howard says. “But Iowa gave him a chance.”
Developing expertise in craniocervical surgery
Menezes’ residency at UI Hospitals & Clinics involved two years of general surgery, followed by four years of neurosurgery training. He also completed fellowship training in pediatric neurosurgery at Iowa.
As he began seeing patients during his neurosurgery residency, Menezes saw extremely high morbidity and mortality rates for patients with diseases and disorders at the junction between the skull and cervical spine.
At this time, the standard surgical approach was to access the area from the back of a patient’s neck. However, approximately one-third of these patients would die within three days of surgery, according to Menezes. A relatively small number of specialists worldwide had performed transoral (through the mouth) procedures to treat tuberculosis and other conditions in the upper cervical vertebrae. But the medical literature detailing these types of cases was scarce.
As Menezes began considering a transoral approach for his patients, he knew he would need a level of understanding and experience beyond neurology—in orthopedics, ophthalmology, otolaryngology, biomechanics, and other specialties.
“My mentor, Dr. Adolph Sahs, who was an icon in adult neurology [Sahs served as chair of the UI Department of Neurology from 1948-74], said to me, ‘Arnold, I think you’re stepping into no man’s land. You’re going to need a clear understanding across multiple departments to know what they do and what you can do.’” Menezes says. “Fortunately, they all welcomed me. I had tremendous support from all the services, including my neurosurgery mentor, Dr. Carl Graf, and Dr. William Bell in Pediatric Neurology.”
Menezes worked with and learned from colleagues who had developed their own legendary careers at Iowa—Michael Bonfiglio, MD, Carroll Larson, MD, Stuart Weinstein, MD, and Ignacio Ponseti, MD, in orthopedics and Brian McCabe, MD, in otolaryngology—as well as a new generation of specialists such as Bruce Gantz, MD, in otolaryngology, Keith Carter, MD, in ophthalmology, and others.
It was complex, hands-on work, Menezes says, noting that CT (computerized tomography, which combines a series of X-rays using computer processing to create more-detailed, cross-sectional images) was still relatively new technology.
“I designed, performed, and interpreted the radiology procedures, then did the clinical correlations myself,” he says. “I didn’t want to leave it to anybody else because I wanted to understand the underlying problems each patient presented—with the goal of breaking that pattern of high mortality from traditional surgical approaches.”
Creating a database
Around 1978, Menezes started building a database—but without a computer. He’d spend weekends working on spreadsheets, documenting patient cases by hand and archiving the records. The database has since grown to include over 7,000 cases of patients from around the world.
He also became a prodigious disseminator of knowledge and evidence through research manuscripts, textbook chapters, workshops, national and international presentations, and participation in organizations such as the American Association of Neurological Surgeons and the North American Skull Base Society, of which he was a founder.
“Over time,” Menezes notes, “every medical textbook would include a major chapter on the craniocervical junction. Iowa became known as the center of excellence for this. We were describing the problem and designing the solution.”
Menezes and his colleagues addressed dozens of diseases and abnormalities that occur in this region of the brain—basilar invagination, Chiari malformation, Down syndrome, and others.
Over time, every medical textbook would include a major chapter on the craniocervical junction. Iowa became known as the center of excellence for this. We were describing the problem and designing the solution.
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Arnold Menezes
Iowa a global center for craniovertebral abnormalities
As awareness of Menezes’ work grew, patients from around the nation and world were being referred to UI Hospitals & Clinics for consultation. He would spend weekends reviewing cases and dictating letters back to referring physicians. For the extremely difficult or complex cases, he would treat these patients himself.
Menezes also devoted more time to teaching and advising neurosurgery colleagues throughout the country and around the world. He was involved in developing the first hands-on courses in spinal surgery in the U.S. and was instrumental in establishing spinal neurosurgery programs in Asia, Africa, Europe, and South America.
“Over the years, there were more and more people getting involved and doing good work—in London, in Japan, and other places,” Menezes says. “I visited them, and they visited us, and it became an international community focused on craniovertebral abnormalities.”
Training next-generation neurosurgeons
The UI Department of Neurosurgery is recognized for its exemplar residency training program. The program graduates two neurosurgeons each year, and Menezes notes that over the past 20 years, approximately 80% of these graduates have gone on to faculty positions at other major academic medical centers—a point of pride and distinction for the department and the university.
The department also has a successful preclinical fellowship program for medical school graduates who have yet to be accepted into a neurosurgery residency program.
“We give them the opportunity to come here and get exposure and experience in neurosurgery,” Menezes says. “They learn a lot and are better positioned to get into a residency program—here or elsewhere in the country. It’s very competitive, but the word has spread that Iowa is the place to come to get a proper start and a good recommendation.”
Endowed chair supports extended training
In collaboration with the UI Center for Advancement, the Carver College of Medicine in 2016 established the Arnold H. Menezes Chair in Neurosurgery. The endowed chair—made possible by a major philanthropic donation from the family of one Menezes’ patients, plus support from other patients and donors, Menezes’ faculty and staff colleagues, and the Menezes family—helps provide the financial resources to recruit outstanding early-career academic neurosurgeons to join UI Health Care and work and learn directly from Menezes.
“Establishing this position has made an important impact,” Howard says. “To begin to achieve Dr. Menezes’ level of skill and expertise takes a tremendous amount of work and collaboration. This endowed position gave us the resources to provide extended training for talented young neurosurgeons who can carry on as among the best in the world in helping patients with this kind of problem.”
Howard cites two faculty members in the Department of Neurosurgery—Jeremy Greenlee, MD, who serves as the Menezes Chair, and Brian Dlouhy, MD, who returned to the UI after completing a fellowship in pediatric neurosurgery at Washington University in St. Louis—as outstanding clinicians and surgeons who have benefited from working closely with Menezes.
“Dr. Dlouhy and Dr. Greenlee are part of the next generation and carrying on this tradition of excellence that Dr. Menezes started,” Howard says.
Publishing and sharing expertise
Menezes stopped doing surgeries about a year ago, but he still maintains a busy schedule: reviewing cases and seeing patients in clinic, writing manuscripts for publication, and serving on editorial boards for peer-reviewed journals.
“We’re an academic program, and we have a lot of data to share. It all takes time,” he says. “With the number of cases in our database, and the experience we’ve accumulated, no one else compares to what we’ve done.”
Menezes continues to publish case studies, and academic journal editors reach out to him regularly to inquire about his latest manuscript-in-progress.
He’s lost count of the many medals and accolades he’s received over the years, but Menezes is especially proud of the Franc D. Ingraham Award for Distinguished Service and Achievement he received in 2019—the highest honor given by the American Association of Neurological Surgeons and its Congress of Neurological Surgeons Section on Pediatric Neurological Surgery. Menezes is only the 12th recipient of the award since it was established in 1988.
Changing patients’ lives
He's also received hundreds, if not thousands, of letters, cards, and emails from patients and families.
“Graduation invitations, wedding invitations, reunions—lots of them,” Menezes says. “So many of the families stay in touch. And so many of the patients have gone on to do great things in life.”
Caroline Spears is one example.
In 2010, Menezes performed an eight-hour surgery on a 16-year-old Spears, a Texas native who had been diagnosed with Chiari malformation. It’s a condition in which the skull presses on the cerebellum, the part of the brain located in the back of the head that controls balance and other complex motor functions. With Chiari malformation, brain tissue is pushed down into the spinal canal.
Spears had undergone prior procedures at other medical centers to correct the problem but continued to experience frequent migraines and neurological deficiencies when she and her family were referred to Menezes.
“My medical situation was complex, and we came to Iowa after years of trying various methods to solve my health issues, including three surgeries that didn’t pan out. So, we really needed this fourth one to work,” Spears says. “Dr. Menezes and the UI Health Care team took an extremely complex medical situation and gave me a simple result: the ability to live a normal life.”
Today, Spears is founder and executive director of Climate Cabinet, a national organization that analyzes climate change data and makes climate policy solutions actionable for local and state policymakers. This past fall, Spears was named one of Forbes’ 2024 “30 Under 30” leaders in social impact.
“I am indebted to the incredible team at Iowa, and Dr. Menezes’ storied career, for a surgery and treatment plan that has been game-changing,” Spears says.
A legacy of excellence—and resilience
When asked to reflect upon his years at Iowa, Menezes cites a collaborative culture that allowed him to learn and develop his expertise. He also acknowledges the pressure he placed on himself to succeed.
“Being foreign-born, I felt I needed to prove myself—not just here, but anywhere. But once you are accepted, you are part of everything,” he says. “When I came here as a resident, there were few, if any, people of Indian origin in the medical school. If you walk around the hospital today, you’ll see people working here from all different backgrounds. That’s good.”
Howard, who has worked with Menezes for more than 30 years, still marvels at his colleague’s resilience.
“Here’s a guy who wasn’t being given a lot of opportunities coming out of medical school, and yet he found opportunity at the University of Iowa. That says a lot about this place,” Howard says. “He identified a terrible, unsolved problem, and he dedicated himself to understanding and fixing it. And he’s still getting after it. He’s just the toughest nut I’ve ever seen.”
He identified a terrible, unsolved problem, and he dedicated himself to understanding and fixing it. And he’s still getting after it.
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Matthew Howard, MD
An Iowa family’s appreciation for Menezes’ care and expertise
In 1999, Jane Noble Davis and Craig Davis of Washington, Iowa, turned to UI neurosurgeon Arnold Menezes, MBBS, to treat their 8-year-old daughter, Maria, for Chiari malformation, a defect in the cerebellum that extends brain tissue into the spinal canal, and Klippel Feil syndrome, a birth disorder in which two or more vertebrae in the neck are abnormally joined.
Now a certified physician assistant in the vascular surgery clinic at UI Heart and Vascular Center, Maria Davis Hochstedler shared, in her own words, her recollection and gratitude for the care she received a quarter-century ago:
“I can hardly believe it’s been 25 years since I first met Dr. Menezes. To the credit of his expertise and remarkable surgical skill, I have lived a relatively uninterrupted and ‘normal’ life since the time of my diagnosis of Chiari malformation and Klippel Feil syndrome and subsequent neurosurgery in 1999.
“Living so close to University of Iowa Hospitals & Clinics allowed for my early diagnosis and intervention by Dr. Menezes, for whom countless others have traveled far and wide to seek his extremely specialized skill set and extraordinary life’s work. As a child, it felt like my neurosurgical experience was isolated to a six-month experience—a 16-day hospital stay followed by a halo and then two cervical collars. Now, as an adult, I recognize that my experience and interaction with Dr. Menezes were much more significant than my childhood self could have imagined.
“I have been fortunate to have no lasting complications from my underlying conditions or surgery, and I have engaged in a normal life, both as a child and now as an adult. To be honest, I typically forget about my diagnoses and the limitations of my cervical fusion. However, Dr. Menezes’s surgical and professional skills have positively impacted my daily life and very much influenced the person I am.
“Beyond giving me a chance to live a life outside the constraints of my medical diagnoses, he guided my early curiosity in medicine, which eventually led to my professional career as a physician assistant.
“While many of my memories from my surgery, hospital stay, and recovery are a blur, I acutely recall his precise attention to detail and dedication to high medical standards as he meticulously cared for me and all his other patients. These are qualities that I strive to emulate daily as I care for my own patients.
A simple ‘thank you’ is hardly enough to fully express my appreciation for Dr. Menezes, who has greatly impacted my life over the past 25 years. I am so thankful and am forever grateful for his dedication to medicine, the field of neurosurgery, and the University of Iowa as he perfected his knowledge and skill set to become the best surgeon to treat those like me.”
Jane Noble Davis expressed her own appreciation for her daughter’s care.
“Dr. Menezes had the exact skill set and focused dedication needed 25 years ago to ‘fix’ our happy, enthusiastic, energetic 8-year-old daughter,” Noble Davis says. “Words will never do justice in expressing the gratitude Craig and I share for Dr Menezes for Maria's successful neurosurgery story. To Dr. Menezes, I recently wrote: What you have done for Maria’s quality of life and the entire medical world by dedicating your life to a solution ... cannot be written in words. I wish you could read my heart.”
