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Dr. Peter J. Jannetta, Pioneering Neurosurgeon on Facial Pain, Dies at 84

In 1966, Dr. Peter J. Jannetta performed the first microvascular decompression surgery to relieve trigeminal neuralgia.

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 in Pittsburgh. He was 84.

The cause was complications from a brain injury suffered in a recent fall, said Susan Jannetta, his daughter.

Dr. Jannetta, a retired faculty member of the University of Pittsburgh School of Medicine, was considered one of the foremost neurosurgeons in the world.

A specialist in cranial nerve disorders, he was renowned in particular for having identified the minute culprit responsible for trigeminal neuralgia — a condition causing agonizing facial pain — and for developing a way to vanquish that culprit through microsurgery on the brain.

“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.”

Trigeminal neuralgia is so excruciating — and early remedies were so inadequate — that in the past, some patients committed suicide.

“It’s the worst pain in the world,” Dr. Jannetta told The Times Union of Albany in 1999. “The nerve endings in the face are the most concentrated in the body, even more than the fingertips.”

By the time Dr. Jannetta began his residency in the 1960s, it was known that such pain stemmed from damage to the trigeminal nerve, a large nerve that carries sensation from the face to the brain.

But the source of the damage was far less understood, severely limiting opportunities for treatment.

“The treatments up until that time tended to be things that damaged the nerve,” Mr. Shelton said. “You would cut the nerve so it would stop sending these responses. They would pickle it with alcohol. They would use electrical impulses to damage it, and so on. The result would be, at best, numbness. That would eliminate the pain, but also eliminate the nerve’s function."

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.

But if the offending vessel was indeed the cause, Dr. Jannetta reasoned, then the pain could be alleviated by removing it with the aid of a surgical microscope.

Over time, he developed a delicate procedure to do just that. Formally known as microvascular decompression, it is familiarly known among surgeons as the Jannetta procedure.

“If you reach behind your ear, you’ll find a bony lump,” Mr. Shelton said. “And if you move one finger-width over toward your spine, that’s the place where they would drill a hole about the size of a quarter.”

The lens of the microscope was placed against the hole, letting the surgeon peer closely at the trigeminal nerve. Under magnification, the impinging vessel could then be removed.

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.

Today, microvascular decompression is a standard treatment for trigeminal neuralgia, resulting in complete relief in some 90 percent of cases.

Dr. Jannetta trained more than 150 surgeons around the world in the technique. It has been extended to treat a range of conditions — including tinnitus, facial spasms and vertigo — that stem from impingement on various cranial nerves.

Peter Joseph Jannetta was born in Philadelphia on April 5, 1932. He earned a bachelor’s degree in zoology from the University of Pennsylvania in 1953, followed by an M.D. there in 1957. He did a residency in general surgery at Penn before moving to U.C.L.A. for his neurosurgery residency.

Dr. Jannetta was on the faculty of Louisiana State University Medical Center in New Orleans, where he was chief of neurosurgery, before joining the University of Pittsburgh in 1971. Under his stewardship, the university hospital became a mecca for patients suffering from cranial nerve disorders.

From 1995 to 1996, Dr. Jannetta served as the Pennsylvania secretary of health. After retiring from his university post in 2000, he joined the staff of Allegheny General Hospital in Pittsburgh. At his death, he had homes in Pittsburgh and Ligonier, Pa.

Dr. Jannetta’s first marriage, to Ann Bowman, ended in divorce. Besides their daughter Susan, his survivors include five other children from that marriage, Joanne Lenert, Carol Jannetta Alpers, Elizabeth Jannetta (known as Binney), Peter T. and Michael; two brothers, Anthony and Samuel; a sister, Ida Marie Higgins; his second wife, the former Diana Rose; a stepson, Robert Davant III; a stepdaughter, Hilary Rose; eight grandchildren; and two step-grandchildren. Another stepdaughter, Jessica Davant, died in 2006.

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.

While Dr. Jannetta did not introduce the microscope into the operating room, his use of it as a foundation on which to build an entire operation was novel, Mr. Shelton said.

“He recognized early that it permitted the development of new insights and procedures, rather than simply being a clearer way of seeing what people had seen before.”

Mr. Shelton added, “He left a legacy of literally thousands of people that he treated for a condition that was unspeakably painful and resistant to treatment.”

A version of this article appears in print on  , Section A, Page 24 of the New York edition with the headline: Dr. Peter J. Jannetta, Neurosurgeon and Pioneer on Facial Pain, Dies at 84. Order Reprints | Today’s Paper | Subscribe

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