Phone calls, e-mails, and desperate letters. They come by the hundreds, from all over the world, initiated by anxious people seeking specialized care from Arnold Menezes, M.D., a neurosurgeon at University of Iowa Hospitals and Clinics.

It's been that way for years, reflecting Menezes' world-wide reputation as a leading expert-perhaps THE leading expert-on skull base abnormalities. His understanding of the craniocervical junction-the delicate part of the human anatomy where the skull meets the spine-is second to none.

The task of tracking these patient inquiries-at least 100 inquiries a week from patients and physicians seeking second opinions-falls to Menezes' secretary, Mary Jo Piper.

"I'm often the first point of contact for patients," Piper says. "In some ways, my role is to try to calm them down. They have high anxieties and with good reason."

The problem for most of these patients is this: their skulls resemble pumpkins resting on spikes, threatening to topple and cause serious, life-long consequences. Menezes performs highly specialized surgery to fix the problem, giving his patients the chance to lead normal lives.

One of the key elements to Menezes' success involves a unique patient database he started 25 years ago. The database includes the details of 4,800 patients. It has identified many skull base disorders and contributed invaluable information about these complex problems.

"The volume of patients in our database is cumulatively the largest ever," Menezes says. "It has given us the opportunity to not only understand the disease process and location but also understand the natural history and long-term outlook for these patients. There is no laboratory method or animal model to explain this condition. The accumulation of this data has allowed us to do things that could not be done before."

This groundbreaking work reflects the influence of Menezes' background in medicine. He was born in Bombay, India, the son of a physician and grandson of a surgeon. At one time, 22 family members were practicing medicine. His wife, Meenal, is an anesthesiologist at Mercy Hospital in Iowa City and his daughter, Maithilee, is an otolaryngology resident at UI Hospitals and Clinics.

After graduating from medical school in Bombay, Menezes declined a scholarship offer to Oxford, England, and chose to train at the UI Roy J. and Lucille A. Carver College of Medicine, graduating in 1973.

Menezes has never looked back. Since joining the UI faculty in 1974, he has played a significant role in developing the UI Department of Neurosurgery and its teaching activities. In fact, he is one of two neurosurgeons from UI Hospitals and Clinics who played especially prominent roles at this year's Congress of Neurological Surgeons meeting in San Francisco. Menezes was selected the Honored Guest because of his contributions to clinical neurosurgery, while his UI colleague, Vincent Traynelis, M.D., chaired the Congress in his role as the organization's current president.

Accompanying this dedication is a deeply felt appreciation for Iowa and the professional opportunities Menezes has realized at UI Hospitals and Clinics.

"I'm very proud to be part of this institution and where we've come," he says. "I wouldn't have it any other way."