T he focus article by Dr. Jannetta documents in admirable detail the difficulty that an outstanding medical idea occasionally encounters before acceptance. Among antecedents are the role of cholesterol in atherosclerosis, which is about 100 years old; vaccination for smallpox, more than 200 years in complete implementation; and the pernicious effects of tobacco smoking, alluded to by King James I, almost 400 years ago. By contrast, the recognition of arterial compression as a source of trigeminal neuralgia has gone acceptably smooth. It was first advanced by Dandy in 1929, and championed by Gardner more than 30 years later in 1962, but so ineffective were the efforts of these admitted giants in neurosurgery in promulgating this highly significant discovery, that Jannetta, as a young resident and fledgling neurosurgeon, had not even heard of their contributions. The idea was thus not transmitted but born again in his 1966 discovery. Vascular compression of the trigeminal nerve, at its root entry zone into the brainstem is now almost universally acknowledged by neurosurgeons the world over as the major cause of trigeminal neuralgia. Microvascular decompression at this zone, without any division of the nerve, pioneered by Jannetta and Rand, is now widely accepted as an appropriate (but not the only effective) treatment for the condition. The concepts of vascular compression and microvascular decompression, first published in the Journal of Neurosurgery, in 1967, were next taken up in the French literature in 1970, in an Indian publication in 1976,