"Dr. Menezes has a wonderfully big heart and a wonderfully gifted brain. We're all very grateful."

--LaZanne Kiernan

Internationally recognized neurosurgeon spares two brothers and a cousin from likely paralysis

Micah Kiernan was 8 years old when his older brother, Ryan, underwent surgery for a spinal deformity that put him at high risk for paralysis.

Two vertebrae at the base of Ryan's skull had fused and become partially dislocated, applying dangerous pressure to the then-12-year-old boy's spinal cord.

Fortunately, in a story that was documented in the May 1994 issue of PACEMAKER, Ryan underwent two surgical procedures to successfully repair the defect, called basilar invagination with Chiari malformation.

Both surgeries were performed by Arnold Menezes, M.D., a University of Iowa Hospitals and Clinics neurosurgeon who is regarded as one of the world's leading experts in repairing skull base abnormalities. Menezes had, in fact, perfected one of the procedures that Ryan received--a transpharyngeal resection of the bone compression.

Ryan is now a senior at The University of Iowa. Other than occasionally bothersome stiffness in his neck, his activities and behaviors are normal. In fact, as a Delta Upsilon fraternity leader, he was named Greek system "president of the year" at UI.

Given that history, it's no surprise that Ryan's mother, LaZanne Kiernan, became concerned when younger son Micah developed severe migraine headaches in the third and fourth grades.

"Ryan's situation caused me to be very curious, cautious, and persistent about anything involving trouble with the head, brain, or spinal chord," she said.

The Kiernans drove Micah to Sioux Falls, South Dakota, for an examination by MRI. The results, which showed a mild form of Chiari malformation, were sent to Menezes. Even though the condition was apparently unrelated to Ryan's, surgical repairs to fix the skull base deformity were essential … preferably right away.

"Dr. Menezes' compassionate heart led him to ask Micah what he would miss the most if he had to give up something during his months of recovery," LaZanne said.

Micah told Menezes he was a senior section leader in the Pride of the Dutchmen band marching band, a prestigious performance group that participates in street and field competitions throughout the fall (wooden shoes are worn in street performances).

"So Dr. Menezes said that if we watched Micah closely we could delay surgery until the end of marching season," LaZanne said.

Micah's symptoms remained manageable until his headaches worsened, his motor skills declined, and his school work began slipping. Thus, on October 29, 2003, the Kiernans entrusted the future of a second son to the surgical skills of Menezes and the neurosurgery team.

Now, with Micah fully on the mend, his future seems bright. "Once the healing is over--and that will take up to a year--Micah's life should be pretty much normal from here on out," Menezes said.

The story doesn't end there. The ordeals with Ryan and Micah have kept other family members on the alert for possible signs of Chiari malformation. In fact, Ryan and Micah's cousin, Malea Reeves of Broomfield, Colorado, who is now 20 years old, developed headaches and a lot of pain in her legs starting at about age 13.

"I convinced our primary care doctor to get Malea an MRI," said Malea's mother, Lorrie. "I sent the MRI to Dr. Menezes and he called me within the week and reported she had a 'significant' malformation."

During a subsequent appointment, Menezes found she had no gag reflex, spastic reflexes, and saw little or no fluid getting through. Menezes scheduled Malea for surgery, which occurred Feb. 16, 2004.

"I'm doing well now," said Malea, who is attending the University of Colorado.

For more information about Chiari malformation, patients and families may contact UI Health Access toll-free and ask for Dr. Arnold Menezes, or call Menezes directly at 319-356-2768. Physicians may call UI Consult. Callers should mention having seen this story in PACEMAKER.

The University of Iowa's team of internationally recognized neurosurgeons will be especially visible at this year's Congress of Neurological Surgeons, scheduled Oct. 16-21 in San Francisco, California. The Honored Guest is Arnold Menezes, M.D., while the organization's president is UI neurosurgeon Vincent Traynelis, M.D.

Chiari (pronounced kee-ar'-ee) malformation is an uncommon congenital anomaly in which the lower part of the cerebellum protrudes down into the spinal canal. This causes tissue compression and hinders spinal fluid flow. The exact cause is unknown. Scientists have no proof, but there are growing suspicions that Chiari malformation may be hereditary. Research will provide the answers.