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

Freckmann, N.; Hagenah, R; Herrmann, H. D.; Müller, Dieter

doi:10.1007/bf01406346

Cited by 156 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In humans this is indicated by the intraspinal anastomoses between SRAN and DRC 1/2 which were found in normal cadavers 10, 12, is, 17. In agreement with other investigators, Lang frequently found a small ganglion of DRC 1 in juxta position to the anastomosis with the SRAN as well as ganglionic cells within the SRAN 3,7,[13][14][15]19 These findings lead to the speculation that those ganglionic cells function as extension receptors of the sternomastoid and trapezius muscle. So the removal of these ganglions may influence the torticollis symptoms ~5.…”

Section: Discussionsupporting

confidence: 82%

Bilateral microsurgical lysis of the spinal accessory nerve roots for treatment of spasmodic torticollis

et al. 1986

Self Cite

View full text Add to dashboard Cite

In 1981 we reported about a new surgical procedure for the treatment of spasmodic torticollis (ST). 33 patients, who failed to respond to the available conservative treatment, underwent a bilateral microsurgical lysis (BML) of the spinal accessory nerve roots (SRAN). Anastomoses between SRAN and the dorsal roots of the first and second cervical nerve (DRC 1/DRC 2) were cut. DRC 1 and sometimes DRC 2 were divided bilaterally. Moreover, SRAN was freed of all adhesions and vascular contacts. Up to 60 months after surgery we have excellent results in 5(5), good results in 10(7) and improved symptoms in 12(8) patients. In 3(7) patients symptoms were unchanged, 2(1) patients deteriorated (patients self assessment is given in brackets). One patient died during hospitalisation. Comparing torticollis symptoms and the post-operative outcome it can be shown that patients with horizontal ST have the best results (21 out of 22). Bad results were obtained in patients with combined torticollis symptoms such as retrocollis, antecollis and the rotatory/horizontal type (5 out of 9). These results support the hypothesis of a peripheral factor in the aetiology of horizontal ST. It is assumed that a unilateral disturbance of proprioceptive afferents for head control, which reach the CNS via anastomosis between DRC 1/DRC 2 and SRAN (in 94% of the cases) could be involved. This hypothesis is discussed with special regard to different anatomical findings in patients with ST and those revealed in a study on human cadavers without this disease.

show abstract

Section: Discussionsupporting

confidence: 82%

Bilateral microsurgical lysis of the spinal accessory nerve roots for treatment of spasmodic torticollis

et al. 1986

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since Freckmann et al [6] reported their experiences of treatment with microvascular lysis of the spinal accessory nerves in 1981, others have reported their successful surgical results with microvascular decompression [7,16,17,19,24]. The operative procedure in our cases differs from that of Freckman et al [6,7] in that we do not perform nerve sections.…”

Section: Introductioncontrasting

confidence: 46%

“…Freckmann et al in 198l, reported a series of 11 patients with ST treated with microvascular "lysis" of the spinal accessory nerves utilizing the concept of vascular compression of these nerves as a cause of ST [6]. They observed "good" or "improved" results in 10 out of 11 patients.…”

mentioning

confidence: 93%

See 1 more Smart Citation

Microvascular decompression for spasmodic torticollis

Jho

Jannetta

1995

Acta neurochir

View full text Add to dashboard Cite

Twenty patients with spasmodic torticollis (ST) were treated by microvascular decompression (MVD) of the spinal accessory nerves, the upper cervical nerve roots and the brainstem. Thirteen were female and seven male. Median age was 47 years (range 39 to 70 years). Median duration of symptoms was 5 years (range 4 months to 17 years). Ten had right horizontal; nine, left horizontal; and one, retrocollis ST. Twenty-two operations were performed on twenty patients, suboccipital craniectomy and C1 laminectomy in 18 and retromastoid craniectomy in 4 operations. The most common compressing blood vessels were the vertebral artery and/or the posterior inferior cerebellar artery. No nerve section was performed. Three patients died of unrelated conditions, 3, 5 1/2, and 6 years postoperatively, respectively. Minimum follow-up period in the rest of the cases is 5 years (range 5 to 10 years). Thirteen (65%) were cured, four (20%) improved with minimal spasm, one (5%) improved with moderate spasm, and two (10%) improved minimally or unchanged. In most cases the cure or improvement was noticed gradually over 6 months to two years following the operation. There was no operative mortality. Postoperative morbidities included transient cerebrospinal fluid leakage through the surgical incision in one case and an apparent multiple small vessel stroke involving periventricular white matter in one reoperation case with full recovery. MVD for ST is a nondestructive benign procedure with high probability of cure or significant improvement.

show abstract

“…The finding in this investigation of PICA stemming from the basilar artery in 11 % of the cases was in agreement with Brunner [ 1] who reported 7.1% with Lang and Kollmannsberger [9], as well as with Muller [10] who reported 10%. A deep PICA loop, which Lang [8] reported in 10% of the cases and which occasionally was found intraoperatively on torticollis patients [2][3][4][5], was not reported in this investigation. Also in no case was double formation of PICA, which Lang [8] reported in 0.9% of the cases found, nor was the island formation of PICA described by Stopford [ 14] observed.…”

Section: Discussionmentioning

confidence: 55%

Anatomic Topographical Relationship of the Intraspinal Accessory Root to the Upper Cervical Roots and to the Vessels of the Cranial Cervical Region

Hagenah

Freckmann

1983

Cells Tissues Organs

Self Cite

View full text Add to dashboard Cite

The object of this investigation was to provide a statistical interpretation of macroscopic anatomic findings in the cranial cervical region, which is very rich in variation. In this way rare nervous and vascular variations could be related statistically. The first cervical posterior root demonstrated the most striking variations, which, according to anlage and connection with the accessory nerve, was divided into four anlage types of formation. In this way it was shown that in only 23% of the cases, no posterior C-1 root had been formed. It was further demonstrable that in at least part of the cases the accessory nerve was sensibly mixed with the first posterior root. Furthermore, nervous structures and peculiarities in the vessels were investigated. Special courses taken by the posterior inferior cerebellar artery, in addition to those already known, were statistically interpreted. Nervous as well as vascular contact and courses were analyzed, especially in relation to their topography to the accessory nerve, in order to provide clinicians with possibilities for explanations of irritations or compressions of this cranial nerve.

show abstract

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

Cited by 156 publications

References 24 publications

Bilateral microsurgical lysis of the spinal accessory nerve roots for treatment of spasmodic torticollis

Bilateral microsurgical lysis of the spinal accessory nerve roots for treatment of spasmodic torticollis

Microvascular decompression for spasmodic torticollis

Anatomic Topographical Relationship of the Intraspinal Accessory Root to the Upper Cervical Roots and to the Vessels of the Cranial Cervical Region

Contact Info

Product

Resources

About