[Effects of treatment of spasmodic torticollis by neurovascular decompression, myotomy, and toxin type A: a comparative study].
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.
Sun
Ke-Hua
KH
Department of Neurosurgery and Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Lu
Yi-Cheng
YC
Hu
Guo-Han
GH
Luo
Chun
C
Hou
Li-Jun
LJ
Chen
Ju-Xiang
JX
Zhou
Jian
J
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
D019274:Botulinum Toxins, Type A