Surgical treatment of spasmodic torticollis: is there a role for microvascular decompression? With an illustrative case report.
Spasmodic torticollis (ST) is a puzzling movement disorder, characterized by involuntary tonic or clonic contractions of various neck muscles. From time to time, psychogenic, extrapyramidal and neuroperipheral origins have been postulated and reflecting the variety of theories proposed, as many different treatments have been attempted, none of which has shown absolute effectiveness. Surgery of ST classically includes destructive procedures such as myotomies, stereotactically placed lesions, rhizotomies and neurectomies. The recent application of the concept of "neurovascular conflict" to ST induced several authors to perform microvascular decompression (MVD) in these patients, with encouraging and in some cases long-lasting results. Our case report joins this group. From the analysis of pertinent literature we conclude that: a. Spasmodic torticollis is probably a collection of separate clinical entities; b. Even in the so-called "ST of neuroperipheral origin" some coexising central factor must be admitted; c. Neurovascular compression underlies at least some cases of ST. Historical, anatomical, physiopathological and clinical aspects of ST are extensively discussed.
Division of Neurosurgery G.M. Lancisi, San Camillo Hospital, Rome, Italy.
A
A
Brunori
R
R
Greco
P
P
Bruni
A
A
Delitala
F
F
Chiappetta
D019299:Decompression, Surgical; D005314:Embryonic and Fetal Development / Q000502:physiology; D005260:Female; D006801:Humans; D008833:Microcirculation / Q000601:surgery*; D008875:Middle Aged; D013035:Spasm / Q000150:complications*; D014103:Torticollis / Q000196:embryology / Q000209:etiology / Q000601:surgery*; D014711:Vertebral Artery / Q000196:embryology