Innovation in neurosurgery: Walter Dandy in his day

In 1925, Walter Dandy published a preliminary report of an innovative operative procedure for patients with tic douloureux. Dandy reported treating tic by selectively sectioning the trigeminal nerve at the brain stem. His operative field was the cerebellopontine angle, which he exposed using a cerebellar approach. It is commonly acknowledged among neurosurgeons that Dandy's technique was overlooked in favor of the Spiller - Frazier procedure during Dandy's lifetime and for at least 15 years after his death. This article examines historically Doctor Dandy's ideas regarding the treatment of tic and evaluates them within the context of the emerging development of the profession of neurological surgery from 1920 to 1945. It documents that his operative approach was accepted and used among an elite group of neurosurgeons. It also discusses political, personal, social, and technological issues that contributed to the overall rejection of the Dandy procedure.