Surgery of Intermittent Torticollis: Results and Prospects

Shtange L.*, Shaginyan G.**, Dreval .**

* City Clinical Hospital N 67, Moscow, Russia;
** Department of Neurosurgery, Medical Academy of Postgraduate Education, Moscow, Russia

 

An indiscriminate approach to surgery of intermittent torticollis (IT), which had existed earlier and consisted in using operations of the same type in various forms of this diseases, turned out to have no future.

Material and Methods. There were 44 operations for IT, made in 1989-2005. Unilateral and bilateral microvascular decompressions (MVD) of accessory nerves were performed in 11 and 29 cases respectively. Complete restoration was watched in 20% of patients. A forced change of a head position reduced by 50% in 40% of cases. As for the rest cases, the operation efficacy was considerably lower. Our experience demonstrated advantages of bilateral MVD over a unilateral one; impossibility and no necessity of angiographic confirmation of bilateral vascular compression of accessory nerves, which was quite clearly seen during operation; low efficacy of MVD in laterocollis. Cases with laterocollis (4) were subjected to two types of operations. Transaction of the accessory nerve and C1-C3 sensory and motor roots on the side of forced bending of a head was made in 1 case. The symptoms of torticollis disappeared immediately after operation; however, they appeared again in 2 months. Extradural transaction of the accessory nerve and myotomy of musculus splenius capitis and musculus lavatory scapulae was performed in the rest 3 cases. Thus, all the muscles, participating in hyperkinesis, were excluded. The patients had only a slight bending of a head, conditioned by gross spondyloarthrosis on the affected side.

Conclusion. The obtained results showed, that an effect of MVD was unpredictable. It was connected with difficulties of IT differentiation and dystonia musculorum deformans. Determination of absolute indications for MVD of accessory nerves demands further studies.