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Neurosurgical Establishment Waited Decade to Adopt Jannetta's Cure

(p. C6) Dr. Peter J. Jannetta, a neurosurgeon who as a medical resident half a century ago developed an innovative procedure to relieve an especially devastating type of facial pain, died on Monday [April 1?, 2016] in Pittsburgh.

. . .

"This was a condition that had been documented for a thousand years: There are references in the ancient literature to what was originally called 'tic douloureux,' " Mark L. Shelton, the author of "Working in a Very Small Place: The Making of a Neurosurgeon," a 1989 book about Dr. Jannetta, said in a telephone interview on Thursday. "People knew of this unexplained, very intense, episodic facial pain but didn't know the cause of it."

. . .

In the mid-1960s, Dr. Jannetta made a striking discovery while he was a neurosurgical resident at the University of California, Los Angeles. Dissecting a set of cranial nerves for a class presentation, he noticed something amiss: a tiny blood vessel pressing on the trigeminal nerve.

"It came to him as something of a flash of insight," Mr. Shelton said. "He saw this blood vessel literally impinging on the nerve so that there was actually a groove in the nerve where the vessel pressed."

What if, Dr. Jannetta wondered, this were the source of the nerve damage? Though his insight is universally accepted today, it was novel to the point of subversion in the 1960s.

"The idea that a very small blood vessel, the diameter of a mechanical pencil lead, could cause such outsize pain didn't resonate with people at the time," Mr. Shelton said.

. . .

If the vessel was a vein, it could simply be cauterized and excised. If it was an artery, however -- a more essential structure -- it would, Dr. Jannetta realized, have to be gently nudged out of the way.

He created a means of doing so that involved slipping a tiny pad of soft Teflon, about the size of a pencil eraser, between the artery and the nerve.

Dr. Jannetta performed the first microvascular decompression operation in 1966. The patient, a 41-year-old man, was relieved of his pain.

It took about a decade for the procedure to win acceptance from the neurosurgical establishment, owing partly to Dr. Jannetta's youth and partly to the novelty of his idea.

"He convinced many, many skeptics -- and there were a lot of skeptics in the early years -- because it seemed so counterintuitive as to what caused neurological disease," Mr. Shelton said.

. . .

His many laurels include the medal of honor from the World Federation of Neurological Societies; the Olivecrona Award, presented by the Karolinska Institute in Sweden; and the Horatio Alger Award, which honors perseverance in the face of adversity or opposition.

For the full obituary, see:

MARGALIT FOX. "Dr. Peter J. Jannetta, Neurosurgeon and Pioneer on Facial Pain, Dies at 84." The New York Times (Fri., APRIL 15, 2016): A22.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary has the date APRIL 14, 2016, and has the title "Dr. Peter J. Jannetta, Pioneering Neurosurgeon on Facial Pain, Dies at 84.")

The book about Jannetta, mentioned above, is:

Shelton, Mark. Working in a Very Small Place: The Making of a Neurosurgeon. New York: Vintage Books, 1990.

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