title: [Effects of treatment of spasmodic torticollis by neurovascular decompression, myotomy, and toxin type A: a comparative study].
abstract: OBJECTIVE
  To compare the effects of treatment of spasmodic torticollis (ST) by neurovascular decompression, myotomy, and botulinum toxin type A and to investigate the mechanism of ST.
  
  
  METHODS
  Nine ST patients who failed to respond to other conservative treatment methods underwent neurovascular decompression of accessory nerve. The effect of decompression was compared with that by botulinum toxin in 22 patients and that by myotomy in 13 patients.
  
  
  RESULTS
  The symptoms and signs were improved to a certain degree by botulinum toxin treatment at first, but recurred and gradually worsened in several months. None of the 22 patients had reached a real cure by botulinum toxin type A treatment. Four of 13 patients undergoing myotomy improved a lot in the symptoms and 9 improved only a bit. However, weakness in neck movement was found in all patients after myotomy. Neurovascular decompression was performed on 9 patients, 5 of which had botulinum toxin treatment and 1 had undergone myotomy, and found that all of them had severe vascular compression in the accessory nerve. Obvious alleviation of symptoms was achieved 2 - 14 days after the operation in 8 patients, and 3 months later in 1 patient. All of the 9 patients resumed their nonenal work and life 6 months after the operation. No complication, such as nerve damage, infection, hemorrhage, leakage of cerebrospinal fluid, and weakness of neck, was found.
  
  
  CONCLUSIONS
  Neurovascular compression may be the most important cause of ST. Microneurovascular decompression is effective for some patients. However, it is still difficult to judge its indication.
authors.affiliation: Department of Neurosurgery and Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Ke-Hua
authors.initials: KH
authors.lastname: Sun
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Lu
authors.forename: Guo-Han
authors.initials: GH
authors.lastname: Hu
authors.forename: Chun
authors.initials: C
authors.lastname: Luo
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Hou
authors.forename: Ju-Xiang
authors.initials: JX
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008875:Middle Aged; D009334:Neck Muscles / Q000601:surgery; D011379:Prognosis; D014103:Torticollis / Q000188:drug therapy* / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A