Authors: Anthony M. Kaufmann, MD; Angela Price, MD (Winnipeg, Canada)
Jannetta, assigned to prosect cranial nerves specimens for dental students while a neurosurgery resident, in 1965, identified the portio intermedius of the trigeminal nerve. He proposed preservation of these sensory fibers may avoid complete facial numbness, and together with Robert Rand developed a sub-temporal trans-tentorial approach for selective rhizotomy for trigeminal neuralgia. Such rash surgery, utilizing an operating microscope, was then forbidden at their UCLA center, so they collaborated with John Alksne to perform the first surgery at Harbour General Hospital. Upon visualizing the trigeminal nerve, Jannetta was surprised to see a pulsating artery compressing the nerve and said “That’s the cause of the tic.” He also hypothesized that alleviating the observed vascular cross-compression may be curative.
A few months later, while assessing a patient with hemifacial spasm, Jannetta had the epiphany this was the same disease process as TN but instead affecting the facial nerve. The patient consented to what would become Jannetta’s first MVD procedure. As the senior faculty members who had forbidden such surgery were away, the supervising neurosurgeon, Paul Crandall, granted the approval to perform the surgery and assisted. Through a retromastoid approach in sitting position and utilizing the operating microscope, Jannetta identified and alleviated the culprit neurovascular compression with a resulting cure.
Jannetta presented his neurovascular compression theory and operative findings to the neurosurgical patriarchy of the time. Elders of the field were generally not inclined to accept the bold speculations of an untested neurosurgeon, and were often determined to discredit the new “cure” of the old diseases.
Over decades of refining his surgical technique, documenting the outcomes and enduring the skepticism he often faced, Jannetta’s theory and his MVD procedure withstood critical analysis and have become recognized as one the great discoveries and advances in Neurosurgery and Medicine.