Treatment of neurogenic torticollis by microvascular lysis of the accessory nerve roots ? indication, technique, and first results

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Abstract
For treatment of spasmodic torticollis (s.T.) microsurgical decompression of the intraspinal-intracranial portion of the accessory nerve (a.N.) has been performed in 11 patients with proved neurogenic lesions of the accessory nerve-dependent muscles. Neurogenic lesions were discovered by meticulous electromyographic (EMG) examination in 26 out of 32 patients with s.T. Based on the EMG findings the a.N. roots were exposed, mostly bilaterally. During operation we found in each case tight adhesions to adjacent structures, in particular the vertebral artery (v.A.), the posterior inferior cerebellar artery (PICA), and spinal arteries. Moreover, various nerve anastomoses were found between the upper dorsal cervical roots and the spinal a.N. roots. After neurovascular lysis and dissection of anastomoses, to C 1 in particular, the a.N. was protected with teflon-foam (Prosthex). Immediately after surgery torticollis had improved in all but one case. Further improvement was achieved by exercises. These first favourable results, and the fact that nerve decompression is less destructive than other surgical procedures in treatment of s.T., make us feel justified in recommending this procedure further to patients suffering from s.T. with proved neurogenic lesions.