Operating Inside the Brain and Outside the Box

Lincolnwood Review

Dr, Jonathan Citow gazes out his office window and comments that he's only a few blocks from the place where he worked as a youth, dreaming of a career in the medical profession.

A childhood spent watching M.A.S.H. sparked his interest in medicine, and fitting customers with wing tips at Florsheim Shoes at Old Orchard Shopping Center was merely a means to that end.

“There were plenty of It doesn't take a brain surgeon jokes back then,” Citow recalls with a smile. “I think some people are still surprised that I made it”.

He has more than made it. At 34, the Wilmette native and graduate of New Trier High School and Johns Hopkins University is considered one of the most innovative neurosurgeons in practice. A top medical school graduate, he completed his residency at the University of Chicago Medical Center and received the second highest score in the country on the Neurosurgery Boards.

Citow, who specializes  in adult and pediatric brain and spine disorders, maintains his North Shore roots both personally and professionally. He lives in Lake Forest with his wife Karen, son Benjamin and newborn daughter, Emma, and plans to move next year to Wilmette.

With offices in Skokie and Libertyville, and soon in Evanston and Buffalo Grove, Citow serves on the staffs of St. Francis Hospital, Rush North Shore and Highland Park Hospital. He also remains on staff at the University of Chicago Medical Center where he operates on complex cerebral aneurysms.

When asked what pushes him to innovative, Citow replied that he “likes to think outside of the box. Instead of following the dogma. I am always striving to find a safer, faster, and better way to perform surgical procedures.”

He's helped by a creative mindunwavering determination and skilled hands. Citow has found that his ability to work in three-dimensional materials is an enormous help in neurosurgery.

“An old expression that I heard during my training was that a neurosurgeon's hands have to be steady enough to draw the Sistine Chapel on the head of a pin,” Citow said.

“The reason manual dexterity is so important is that we work in very small spaces with delicate instruments”, he explained. “The hands need to be gentle, steady and sure because a millimeter one way or the other (when working in the brain or spine) can mean the difference between paralysis, blindness, loss of speech or ending up totally normal. The stakes are always quite high”.

Continual advances in technology have improved the techniques employed by neurosurgeons, but a doctor nevernreally knows exactly what he or she will face until the surgery is underway.
“Even with modern imaging studies such as CAT scans and MRIs, we ocasionally have to improvise during the case. One needs the ability to solve complex problems quickly and not become flustered or panicked”, said Citow.

In the past year he has perforned many complicated surgeries. One patient was an 80-year-old woman who had lost the function in her left arm and leg due to an inflammatory mass that was compressing an area of the spinal cord just under her skull.

By operating through her mouth and making an incision in the back of her throat, Citow was able to remove the anterior part of the top two vertebrae, allowing him to see the lesion. Under the microscope the abnormal tissue was successfully removed from the spinal cord. A fusion was then performed on the first and second cervical vertebrae and the woman made a dramatic recovery.

Another recent case involved the removal of a brain tumor the size of a grapefruit pushing up on the undersurface of a man's brain from the base of his skull. The 60-year-old patient had suffered gradual deterioration of his intellectual function to the point that he was nonambulatory, incontinent and living in a nursing home.

After the tumor was completely removed, he made a dramatic improvement and is currently back at work, driving and painting.

For cancer patients suffering from debilitating chronic pain, Citow implants morphine pumps no larger than a man's wallet into their abdomen, with a catheter extending to the spine.

These devices continually bathe the spinal cord with morphine, providing excellent pain relief at 1/300th of the dose needed if taken orally.

Citow has also performed numerous successful endoscopic and microscopic lumbar diskectomies, with his patients being discharged from the hospital the same day.

He explained that his personal style of surgery is geared to require less operative time,(hence less anesthesia), less recovery time and less stress on the body. Because he's adept at working with the newest technology, patients have smaller incisions and less discomfort after surgery.

However, he added, “Most people are reluctant to have brain and spine surgery because in previous decades the success rates were much lower and the complication rates higher. Now it's a totally different ballgame.”

Citow's style as a physician is also a different ballgame than the stereotype of the aloof surgical specialist. Patients appreciate his caring approach, easy personality and ready accessibility. He gives patients under his care his cell phone number, urging them to call any time of day or night with questions or concerns---and they do.

Citow's diverse interests outside of medicine include gourmet cooking, astronomy, skiing, scuba diving and playing saxaphone. But these don't interfer with his academic accomplishments.

He has authored three medical textbooks: “The Neurology Board Review Book”, already published, “Neuroanatomy and Neurophysiology,” which is geared to medical students and residents, and “Neurophatology and Neuroradiology,” geared to doctors in all fields. Both will be out May 1.