A history of the Jannetta procedure.

Peter Jannetta was a neurosurgery resident when he proposed the neurovascular compression theory. He built upon the astute observations of Dandy, Gardner, and others who, in the era before the operating microscope, had successfully ventured into the posterior fossa. In 1965, Jannetta performed cranial nerve microdissections for dental students and identified the trigeminal portio intermedia. He proposed that preservation of these sensory fibers may avoid complete facial numbness, and together with Robert Rand developed a subtemporal transtentorial approach for selective rhizotomy for trigeminal neuralgia (TN). Such rash surgery, using an operating microscope, was then forbidden at their University of California, Los Angeles center, so they collaborated with John Alksne to perform the first surgery at Harbor General Hospital. Upon visualizing the trigeminal nerve root, Jannetta was surprised to see a pulsating superior cerebellar 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 that this was the same disease process as TN, but instead affecting the facial nerve. The patient consented to what would become Jannetta's first microvascular decompression procedure. The senior faculty members who had forbidden such surgery were away, so the supervising neurosurgeon, Paul Crandall, granted the approval to perform the surgery and assisted. Via a retromastoid approach with the patient in the sitting position and using the operating microscope, Jannetta identified and alleviated the culprit neurovascular compression, with a cure resulting.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 microvascular decompression procedure withstood critical analysis and have become recognized as one the great discoveries and advances in neurosurgery and medicine.

Microdescompresión vascular en la neuralgia esencial del trigémino / Microvascular decompression for essential trigeminal neuralgia

Objetivo: Determinar los resultados de la microdescompresión vascular (MDV) en los pacientes con diagnóstico de neuralgia esencial del trigémino no controlados con el tratamiento médico.Métodos: Se realizó un estudio retrospectivo de una serie con neuralgia esencial del trigémino operados por MDV en los Hospitales Clínico Quirúrgicos “Lucía Iñiguez Landín” y “Hermanos Ameijeiras” en el período comprendido de enero del 2001 a marzo del 2016. Se analizaron las variables edad, sexo, ramas neurales afectadas, tipo de compresión vascular más frecuentemente encontrada,complicaciones y recidivas.Resultados: La muestra quedó conformada por 61 pacientes. El sexo femenino fue el más afectado. Mayormente los casos tenían entre50 y 60 años de edad. Las ramas más afectadas fueron la tercera y la asociación de la segunda y tercera rama para un 43,1 (Por ciento) (22) y 21,5(Por ciento) (11) respectivamente. La sepsis de la herida y la fístula de LCR fueron las principales complicaciones con 13,7 (Por ciento) (7) y 9,8 (Por ciento) (5). En el transoperatorio se encontró la compresión vascular en el 60,3 (Por ciento) (31), siempre relacionado con arteria cerebelosa superior. El 88 (Por ciento) (45)de los pacientes operados no presentaron recidiva.Conclusiones: La MDV es efectiva, tanto, para aliviar el dolor, como para preservar las estructuras y funciones neurales, con una mínima aparición de recidivas(AU)

Objective: To determine the outcome of microvascular decompression surgery (MVD) in patients with diagnosis of trigeminal essential neuralgia uncontrolled by medical treatment.Methods: A retrospective study was carried out in a sample of trigeminal essential neuralgia uncontrolled by medical treatment in “Lucía Iñiguez Landín” y “Hermanos Ameijeiras” Clinic-Surgical Hospital between January of 2001 and march 2016. Variables like; age, gender, neural root affect, intraoperative vascular finding, complication and recurrence of pain were analyzed.Results: The sample included 61 patients. There was a female predominance. The most frequent age group was between 50 to 60 yearsold. The trigeminal root more affected was the V2 and the association V2-V3 with 21,5 (Per cent) (11) and 43,1 (Per cent) (22) respectively. The woundinfection and cerebrospinal fluid leak was the main complication with 13,7 (Per cent) (7) and 9,8 (Per cent) (5) We have found intraoperative vascularcompression in 60,3 (Per cent) (31), always related to the Superior Cerebellar Artery. There was not recurrence in 88 (Per cent) (45) patients.Conclusions: The MVD is an effective technique, so much, to relief pain, like to preserve neural structure, with low incidence of pain recurrence(AU)

Overview and History of Trigeminal Neuralgia.

Although the symptoms associated with trigeminal neuralgia have been well documented, the root cause of this disease initially eluded most surgeons. Although early remedies were haphazard because of a lack of understanding about the condition, near the 20th century both medical and procedural therapies were established for the treatment of trigeminal neuralgia. These treatments include a variety of medications, chemoneurolysis, radiofrequency lesioning, percutaneous ablative procedures, stereotactic radiosurgery, and open rhizotomy and microvascular decompression. This report recounts the history of trigeminal neuralgia, from its earliest descriptions to the historical evolution of nonsurgical and surgical therapies.

Historical review: First facial pain patient admitted to Massachusetts General Hospital, February 1823 and first case series.

Founded in 1811, the Massachusetts General Hospital recently celebrated its bicentennial. The War of 1812 delayed construction of the building so the first patient actually was admitted to the hospital 10 years later, on September 3, 1821. By 1823, the 60 hospital beds were full. Patient 66 was admitted on February 28, 1823, and his hospital course, as described in the admissions book, was transcribed for the Massachusetts General Hospital bicentennial celebration. That case history is reproduced and a case series of 6 similar patients published in 1828 by Dr John Warren, surgeon-in-chief and a founder of the hospital, is presented. In this report, the authors comment on the diagnosis, treatment, and outcome of these patients in the context of the contemporaneous health care environment and in light of the current knowledge of facial pain disorders. This article was adapted from the authors' commentary for the bicentennial celebration.

John Fothergill: a biographical sketch and his contributions to neurology.

John Fothergill was a remarkable but largely forgotten physician, plant collector, and philanthropist, born of Quaker parents in Yorkshire. This article summarizes the legacy of his work on trigeminal neuralgia and migrainous "sick headaches," and his seminal studies on angina, scarlatina, and diptheria. He became hugely influential and fostered both education and many medical careers in Britain and America.

Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'.

BACKGROUND: A review of Dr. Harvey Cushing's surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful treatment. At the time, surgical interventions carried an operative mortality of 20%. METHODS: The Johns Hopkins Hospital surgical records from 1896-1912 were reviewed to contribute new cases to the 20 reports provided by Dr. Cushing in his early publications in 1900 and 1905. This review uncovered 123 TN cases, representing 168 interventions. RESULTS: At the start of his career, Cushing treated TN mainly through Gasserion ganglion extirpations and peripheral neurectomies; however, he nearly abandoned these methods in favor of sensory root avulsion after 1906 and did not perform alcohol injections until his later years at Hopkins. Overall, Cushing had a 0.6% mortality rate; additionally, 91% of patients were improved at the time of discharge. However, 26% of patients had a recurrence requiring further intervention by Cushing. CONCLUSION: Modern day interventions of TN are reflective of the legacy left to us by Harvey Cushing, a pioneering forefather in neurosurgery. He pioneered the infra-arterial approach to excision of the Gasserion ganglion in face of problematic bleeding and later the use of sensory root avulsion to spare motor function. Through the evolution of his legacy and the refinement of original approaches, the quest to advance the treatment of TN took him along the trigeminal nerve from the periphery into the brain.

An autopathography of tic douloureux at the beginning of the nineteenth century.

An Italian lawyer who suffered from tic douloureux wrote an autopathography of his disease documenting a 2-decade history of essential trigeminal neuralgia. The diary reveals a medical history from onset until 1823 when this man was admitted to the Arcispedale Sant'Anna in Ferrara. The documentation was recently discovered in the library of the hospital where it was probably placed when the patient died in 1824. Mr. Ruggiero Ragazzi was a man of notable culture who described the course of his disease and the most accredited treatments of that age. Famous Italian physicians examined and treated the patient. Prescriptions, suggestions, letters were attached to the manuscript as well as other notes on treatments for this type of chronic and recurrent pain. Autopsy excluded secondary neuralgias. Information on clinical and pathogenetic theories about trigeminal neuralgia and the state of diagnostics and therapies in the first years of the nineteenth century are reported.

Esmail Jorjani (1042-1137) and his descriptions of trigeminal neuralgia, hemifacial spasm, and bell's palsy.

Esmail Jorjani was a prominent Persian physician of the 11th and 12th centuries. We present Jorjani's descriptions of probable trigeminal neuralgia, hemifacial spasm, and Bell's palsy. Additionally, on the basis of our translations of his original text, we believe that Jorjani may have been the first to implicate an artery-nerve conflict as an etiology of trigeminal neuralgia. This theory, documented in Jorjani's Treasure of the Khawarazm Shah and elaborated on by Dandy and Jannetta, constitutes the basis of a modern surgical approach to trigeminal neuralgia. The authors also describe the life and works of Esmail Jorjani and review his Treasure for its descriptions related to the aforementioned cranial nerve pathologies.

John Murray Carnochan (1817-1887): the first description of successful surgery for trigeminal neuralgia.

Description of and treatment for trigeminal neuralgia has a long history. One pivotal pioneer in this disease, however, has been more or less lost to history, along with his first description of a series of patients treated successfully for trigeminal neuralgia with surgery. John Murray Carnochan, a surgeon practicing in New York City, performed successful neurosurgery on 3 patients some 3 decades earlier than the first commonly accepted successful procedure by William Rose of London in 1890. In the present paper, the authors discuss the life of Dr. Carnochan and his descriptions of patients with trigeminal neuralgia. Based on this review, John Murray Carnochan should properly be remembered as the first surgeon to perform successful neurosurgery for trigeminal neuralgia.

Historical characterization of trigeminal neuralgia.

TRIGEMINAL NEURALGIA IS a well known clinical entity characterized by agonizing, paroxysmal, and lancinating facial pain, often triggered by movements of the mouth or eating. Historical reviews of facial pain have attempted to describe this severe pain over the past 2.5 millennia. The ancient Greek physicians Hippocrates, Aretaeus, and Galen, described kephalalgias, but their accounts were vague and did not clearly correspond with what we now term trigeminal neuralgia. The first adequate description of trigeminal neuralgia was given in 1671, followed by a fuller description by physician John Locke in 1677. André described the convulsive-like condition in 1756, and named it tic douloureux; in 1773, Fothergill described it as "a painful affection of the face;" and in 1779, John Hunter more clearly characterized the entity as a form of "nervous disorder" with reference to pain of the teeth, gums, or tongue where the disease "does not reside." One hundred fifty years later, the neurological surgeon Walter Dandy equated neurovascular compression of the trigeminal nerve with trigeminal neuralgia.

Trigeminal neuralgia: historical notes and current concepts.

BACKGROUND: Trigeminal neuralgia is a syndrome of paroxysmal excruciating, lancinating unilateral facial pain. REVIEW SUMMARY: There are several clinical features that are characteristic of trigeminal neuralgia, but there may be red flags that should suggest alternative diagnoses. There is convincing evidence that the idiopathic form develops from focal demyelination at the trigeminal root entry zone with subsequent ephaptic cross-talk between axons. Vascular compression of the nerve root causes this demyelination in most patients. Medical management of this condition, using anticonvulsant therapy and other agents, aims to dampen the abnormal electrical signals and to ameliorate symptoms. In refractory cases, a number of surgical interventions can be considered, the most common of which is microvascular decompression of the trigeminal nerve. Gamma knife therapy is emerging as an alternative treatment for the patient with medically refractive trigeminal neuralgia, particularly in the elderly patient with comorbid conditions. CONCLUSION: Knowledge of the proper diagnosis and management of trigeminal neuralgia is essential to the successful management of these patients.

Notas históricas relativas a la Neurocirugía y a la Neuroanestesia en España / No disponible

El presente articulo trata de esclarecer algunos aspectos relativos al desarrollo histórico de la Neurocirugía y de la Neuroanestesia en España durante la primera mitad del siglo XX. El objetivo es el de analizar aspectos puntuales de la historia de la neurocirugía y procurar hacer una aproximación a las primeras experiencias llevadas a cabo por cirujanos españoles; al mismo tiempo que se trata de de perfilar cómo nuestros cirujanos resolvieron los problemas que la anestesia les iba planteando en la nueva cirugía. Basamos nuestra investigación en datos dispersos que hemos hallado en la bibliografía médica española, que analizados nos permiten asegurar que en España se iniciaron las técnicas Neuroquirúrgicas simultáneamente con lo ocurrido en otros países de nuestro entorno sociocultural; sin embargo, estos primeros ensayos no tuvieron continuidad, ya que tan sólo unos pocos cirujanos siguieron practicando muy tímidamente esta cirugía. Antes de los comienzos de la guerra civil española, algunos cirujanos decidieron especializarse en esta nueva rama de la cirugía, y para ello visitaron algunas clínicas especializadas en el extranjero. La guerra civil de 1936-1939 supuso un hándicap importante para poder asistir a clínicas extranjeras por razones obvias, pero en la postguerra inmediata fueron ya más los que iniciaron en España la nueva especialidad y se crearon varios servicios neuroquirúrgicos en Barcelona y Madrid. La Neurocirugía siguió entre nosotros una evolución paralela a lo acontecido en otros países y la neuroanestesia supo responder puntualmente a los muchos retos que aquella le fue presentando a lo largo de la primera mitad del siglo XX, pudiéndose diferenciar claramente cómo los primeros ensayos fueron realizados con anestesia inhalatoria; después, a partir de principios del siglo XX, fue la local y ya en la década de los años cuarenta se inician las modernas técnicas con intubación traqueal y relajación muscular (AU)

In this paper we will clarify several points about the historical development of neurosurgery and neuroanaesthesia in Spain in the first half of XX th century. Our aim is an analysis of specific events of the history of neurosurgery with an approach to the first experiences of Spanish surgeons in this field. Also we will study how the surgeons faced the anaesthesia problems caused by this new surgery. We have based our investigation in the sparse data we found in Spanish medical literature, and we can verify that the beginning of neurosurgery in Spain was in the same period than in other nearby countries. However, apart from isolated experiences, there was not continuity in the neurosurgical practice, and only a small number of surgeons kept on with this activity. Before the onset of the Spanish civil war (1936-1939), a few surgeons decided to specialize in neurosurgery and visited several foreign hospitals. Obviously, the war complicated these stays, but after the war a greater number of surgeons involved in neurosurgery, and several departments of neurosurgery established in Barcelona and Madrid. Neurosurgery followed an evolution similar to that of other western countries, and also neuroanaesthesia evolved accordingly to cope with the new problems of this type of surgery in the first half of XX th century. Inhalatory anaesthesia was the choice in the first trials of neuroanaesthesia, followed by local anaesthesia at the beginning of XX th century. The modern techniques of anaesthesia, including endotracheal intubation and muscle relaxation began in the forties in Spain (AU)

Laqve (wry mouth) considered in Avicenna’s renowned treatise the Canon of Medicine

Hemiespasmo facial, parálisis facial y neuralgia del trigémino son signos y síntomas a los cuales se han enfrentado los médicos durante milenios. Ibn Sina, (conocido como Avicena en Occidente), que fue una de las figuras más importantes de la Edad Media e influyó tanto en Oriente como en Occidente a lo largo de muchos siglos, también prestó gran atención a estos problemas. En su principal trabajo médico, el “Canon de la Medicina”, destacó el significado de la “cara torcida” y escribió un capítulo especial sobre estos procesos con el título de “Laqve”. Sin embargo, el término “laqve” sólo se acepta como tal, en la mayoría de los textos históricos, cuando se refiere a la parálisis facial. El análisis detallado del texto revela que todos los signos y síntomas mencionados se incluyen en el mismo título. Por consiguiente, las descripciones articuladas por el famoso médico Avicena poseen un gran mérito desde el punto de vista histórico de las ciencias neurológicas. La finalidad principal de este artículo es reintroducir partes esenciales del texto, añadiendo comentarios sobre descripciones específicas y, como consecuencia, hacer el texto más comprensible para los científicos de hoy

Hemi-facial spasm, facial paralysis, and trigeminal neuralgia are prevailing signs and symptoms with which physicians have been coping for thousands of years. Ibn Sina (known as Avicenna in the West), who was among the leading figures during medieval ages and influenced the upcoming periods in the Eastern and Western hemispheres for long time, focused also on these crucial problems. In his principal medical work, the Canon of Medicine, Avicenna underlined the significance of wry mouth-related disorders and wrote a precise chapter over this topic with the heading “Laqve.” However, the term “laqve” is usually accepted only as facial paralysis in most of historical texts. Further detailed analysis of the text reveals that, all the above mentioned signs and symptoms are considered under the same heading. Therefore, the descriptions articulated by famous physician Avicenna pose great merit from the point of historical view of neurological sciences. The main aim of this article is to reintroduce essential parts of the text by adding comments over specific descriptions, and consequently, to make the text more comprehensible for today’s scientists

Trigeminal neuralgia.

Trigeminal Neuralgia (TN) is a well recognized syndrome characterized by lancinating attacks of severe facial pain. The diagnosis of TN is based on a history of characteristic pain attacks that are consistent with specific widely accepted criteria for the diagnosis. TN pain attacks may result from physiologic changes induced by a chronic partial injury to the brainstem trigeminal nerve root from a variety of causes. An early and accurate diagnosis of TN is important, because therapeutic interventions can reduce or eliminate pain attacks in the large majority of TN patients.