University of Iowa mourns the loss of world-renowned brain surgeon Arnold Menezes

IOWA CITY — One morning in 1999 — inside her home in Washington, Iowa — an 8-year-old Maria Davis woke up stuck.

“Her shoulders wouldn’t relax,” her mom Jane Noble Davis recalled. “And when it happened a second time, I told our physician that my gut feeling was something’s not right.”

Following an X-ray, their local physician wondered whether Maria might have something called, “Chiari malformation” — a defect in the cerebellum that extends brain tissue into the spinal canal.

“But they said it's rare,” Davis said. “And they doubted that she had it.”

To make sure, they sent the family to the University of Iowa Health Care neurosurgery department and globally-renowned UIHC neurosurgeon Arnold Menezes — who confirmed Maria had the defect along with Klippel Feil syndrome, when two or more neck vertebrae are abnormally joined.

She would need a complex and invasive surgery to correct the problem.

“We were fortunate to know a lot of people who worked at the university who were able to tell us that — he's it,” Davis said. “He's world famous for what he does. He created this procedure, and that's exactly what Maria needed.

“We were fortunate that he was the one and only for Maria.”

Menezes at that time was about halfway through what would become a 50-year globally-esteemed, world-changing, and lives-saving career at the University of Iowa — over which he would innovate novel neurosurgical procedures, author foundational textbooks on craniovertebral abnormalities, deliver more than 800 scientific presentations, establish spinal neurosurgery programs in Africa, Asia, Europe and South American, and treat more than 7,000 patients like Maria.

“They formed a special bond,” Davis said about the doctor and her daughter, who grew up to be certified physician assistant in the vascular surgery clinic at the UI Heart and Vascular Center.

“She often saw Dr. Menezes in the hallway and they would give each other a big hug.”

So when the family learned he was sick, they paid him a visit.

“I went with my girls to see him a week before he died,” Davis said — and they tried to share with him — although lacking words — at least one of their leading emotions. “Gratitude.”

Dr. Menezes died Oct. 30 at age 81. He is survived by his children — Francis and Maithilee and his beloved grandson Sanjiv.

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‘One person in the world’

Born in Mumbai, India, Menezes came from a long line of physicians and surgeons — including his father, grandfather and great-grandfather. As a medical student at Bombay University, he learned that treatments for brain tumors in children were largely unsuccessful and set out to change that — eyeing the United States as offering research opportunities.

But medical residencies were sparse for India-born doctors, according to a UIHC 2024 profile.

“Discrimination,” Menezes said at the time. “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 got his foot in the door through a community hospital in South Chicago, where he learned “what not to do” and the importance of finding an academic medical center where both he and his wife — the late Dr. Meenal Menezes — could complete their residencies.

Some institutions made offers to one or the other but not both — at times criticizing their nationality.

“The general response I got from some of these was, ‘We have better people than you to choose from’,” Menezes told the university last year of the rejection letters he shared with Matthew Howard, UIHC professor and chair of the UI Department of Neurosurgery.

“Just terrible stuff,” Howard said. “Letters saying they’d never take a doctor from India because they’re not competent and they’re not trustworthy. And worse.”

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But UIHC took a chance on them — welcoming Arnold for residency and fellowship training in general surgery, neurosurgery, and pediatric neurosurgery and Meenal for training in anesthesia and cardiac anesthesia. She served as an adjunct clinical professor at UIHC before shifting to Mercy Iowa City.

Menezes joined the UIHC medical faculty in 1974 — when patients with disorders involving the junction between the skull and spine had high morbidity and mortality rates. Specifically, about one-third of these patients would die within three days of having what was the standard surgery at the time — which involved accessing the problem area through the back of the patient’s neck.

In considering alternatives, Menezes looked to a relatively rare method for treating tuberculosis that went through a patient’s mouth. But he knew he would need training beyond neurosurgery — like in orthopedics, ophthalmology, otolaryngology and biomechanics — to chart a new method.

So he reached out to those other departments, and “they all welcomed me,” Menezes told the university — recalling the mentors and colleagues who inspired him through their own innovative careers, like Ignacio Ponseti, who developed the globally-esteemed Ponseti method for clubfoot treatment; and Brian McCabe, former chair of the UI Department of Otolaryngology, who — among other things — oversaw development of multidisciplinary cleft lip-palate management and of cochlear implantation.

With their guidance, Menezes designed, performed and interpreted radiology procedures — which he used in making clinical correlations aimed at breaking the pattern of high mortality rates.

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“He was the one person in the world who really figured out the fine details of a different set of surgical strategies to get to that area, remove the parts of the bone that were pressing on the nervous system, and then stabilize the patient after that intervention,” Howard told The Gazette. “So he would essentially cure these patients.”

Menezes around 1978 started building a patient database — at first by hand — which has since grown to encompass more than 7,000 patient cases from around the world. Through his research and documentation in the form of textbook chapters, manuscripts, workshops, and presentations, Menezes disseminated his novel — and much more successful — surgical strategies to physicians around the world.

“It’s still very dangerous and difficult, but there now are surgeons around the world who have adopted his practice,” Howard said, including at Iowa — where surgeon Brian Dlouhy trained directly under Menezes, allowing him to continue Iowa’s prominence as a global center for craniovertebral abnormalities.

“He has taken that over,” Howard said, “and gets patients from all over the country.”

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‘He was the expert’

Beyond Chiari malformation, Menezes and his colleagues over the years addressed dozens of neuro-related diseases and abnormalities including basilar invagination and Down syndrome. In 2015, Menezes cared for a 3-year-old Congolese boy named Moise Irakiza who was born with a hole in the front of his skull — allowing his brain to grow through it.

The defect created a facial deformity in the child — whose growing brain was pushing aside his eyes. Menezes and his team performed multiple surgeries to correct the malformation and reconstruct the child’s face — allowing him to continue his childhood like any other.

“If there's anything you can say about Dr. Menezes, he truly helped me,” the child’s mother Nyamamyana Natutsi told The Gazette in 2020. “And God will pay him back.”

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Davis had similar feelings about Menezes’ impact on Maria’s life. Despite the extreme risk of the 12-hour procedure their daughter had to endure at age 8, neither she nor her husband Craig Davis doubted the surgeon’s steady hand.

“We knew that he was the expert,” she said.

“He just said, ‘This is really serious. But I can fix it’,” Craig said. “He said, ‘But don’t research anything on the internet. Because I’m the expert.”

When it was over, Menezes got back into this suit and tie to meet with the anxious parents.

“And he said, ‘It went exactly as I planned’,” Craig said.

Given the complexity of the invasive procedure, Maria required a ventilator and a week in the pediatric intensive care unit — spending a total of three weeks in the hospital. Because Menezes accessed her brain through her soft palate, Maria had to be on a soft diet for a while.

“But she had no residual effects — speech or cognitive,” Craig said — noting she did lose permission to participate in one of her favorite activities. “He said, ‘No more tumbling ever.’”

Like other families, the Davises highlighted Menezes’ charming bedside manner — talking directly to the kids about their health care and listening to their questions, which Maria had a lot of.

“The day before her surgery, when we went in for her pre-op … Maria came in with her page of 13 questions,” Jane Noble Davis said, and Menezes answered them all — like “What am I going to do all day?”

“He said, ‘You’re going to sleep’.”

“She said, ‘How are you going to stay awake all day?’” her mom said. “And he said, ‘I drink Jolt’.”

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When asked years later to articulate the impact Menezes had on her family, Jane said she struggled.

“If you're the recipient of his gifts, there are no words,” she said. “What you've done for Maria's quality of life and the entire medical community by dedicating your life to a solution cannot be written in words. I wish you could read my heart.”

Even after Menezes’ passing, he and his wife continued giving — donating $4.2 million to the UI health system to be split between two funds:

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com