1Section of Neurosurgery, Department of Surgery, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada; and.
2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Neurosurg. 2019 Feb 1;132(2):639-646. doi: 10.3171/2018.10.JNS181983. Print 2020 Feb 1.
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.
彼得·詹内塔（Peter Jannetta）在成为神经外科住院医师时提出了神经血管压迫理论。他在丹迪（Dandy）、加德纳（Gardner）等人的敏锐观察基础上进行了研究，这些人在手术显微镜出现之前就已经成功地进入了后颅窝。1965 年，詹内塔（Jannetta）为牙科学员进行颅神经显微解剖，并确定了三叉神经中间部分。他提出，保留这些感觉纤维可能避免完全面部麻木，并且与罗伯特·兰德（Robert Rand）一起开发了一种经颞下入路选择性三叉神经根切断术（rhizotomy）治疗三叉神经痛（TN）的方法。在加利福尼亚大学洛杉矶分校，这种使用手术显微镜的草率手术是被禁止的，因此他们与约翰·阿尔克斯内（John Alksne）合作，在港景总医院进行了首例手术。在观察三叉神经根时，詹内塔（Jannetta）惊讶地发现搏动的小脑上动脉压迫着神经，并说道：“这就是抽搐的原因。”他还假设缓解观察到的血管交叉压迫可能是治愈的原因。几个月后，在评估一位面肌痉挛患者时，詹内塔（Jannetta）突然意识到这与 TN 是同一疾病过程，但影响的是面神经。该患者同意进行詹内塔（Jannetta）的首例微血管减压手术。禁止进行此类手术的资深教员不在，因此，监督神经外科医生保罗·克兰德尔（Paul Crandall）批准并协助进行了手术。詹内塔（Jannetta）通过患者坐位下的后颅窝入路并使用手术显微镜，确定并缓解了罪魁祸首的神经血管压迫，从而达到治愈效果。詹内塔（Jannetta）向当时的神经外科学术权威介绍了他的神经血管压迫理论和手术发现。该领域的资深人士通常不愿意接受未经试验的神经外科医生的大胆推测，并且常常决心诋毁这些旧病的新“疗法”。经过数十年的手术技术改进、结果记录和对他经常面临的怀疑的忍受，詹内塔（Jannetta）的理论及其微血管减压手术经受住了批判性分析，并已被公认为神经外科和医学的重大发现和进步之一。
