Historical Evolution of the Microvascular Decompression Procedure for Trigeminal Neuralgia: From Dandy to Jannetta

Osamah Choudhry, MD1, Bradley Kushner, MD1, Pratik Shukla1, Ronald Apfelbaum, MD1, James Liu, MD1

1Newark, NJ United States

Keywords: trigeminal neuralgia, microvascular decompression, History, Microsurgery, vascular

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     Although the symptoms associated with trigeminal neuralgia have been well documented throughout the history of medicine, the root cause of the disease initially eluded surgeons.
      Walter Dandy made use of a lateral suboccipital craniectomy to provide exposure of the trigeminal nerve for partial sectioning in patients with trigeminal neuralgia. During these cases, Dandy was able to make unique intraoperative observations which contributed to identifying the cause of trigeminal neuralgia.
     A historical review was performed of Dandy’s work on trigeminal neuralgia including papers, book chapters, and intraoperative notes taken on the surgeries he performed to treat the condition.
     Despite not having the use of an operative microscope, Dandy was able to make unique intraoperative observations about arterial and venous compression of the trigeminal nerve. His work towards attempting to identify the cause of trigeminal neuralgia was subsequently used by James Gardner to prove that the pain associated with the condition was a result of an underlying anatomic problem. Peter Jannetta, who was the first surgeon to use the intraoperative microscope for the treatment of trigeminal neuralgia, confirmed Dandy’s original observations that compression of the root entry of the trigeminal nerve was the cause of the often unbearable pain. Through his observations, Jannetta perfected and publicized the microvascular decompression surgery.
     This is a retrospective review.
     Dandy’s observations regarding the compression of the trigeminal nerve root during his operations for trigeminal neuralgia was crucial to subsequent identification of the root cause of the disorder.
     His observations were also crucial for the development of surgical techniques to help correct the condition.


Project Roles:

O. Choudhry (), B. Kushner (), P. Shukla (), R. Apfelbaum (), J. Liu ()