Effects and Complications of the Upper Cervical Rhizotomy in Spasmodic Torticollis

To determine the effects and its complications of ventral cervical and selective spinal accessory nerve rhizotomy in the spasmodic torticollis, 14 patients who had undergone surgery between 1989 and 1997 were reviewed retrospectively. In overall twenty four operations were performed. The ventral cervical rhizotomy with spinal accessory nerve rhizotomy were performed in nine patients and the ventral cervical rhizotomy without spinal accessory nerve rhizotomy were done in two patients. Five cases of sternocleidomastoid myotomy with or without peripheral accessory neurectomy, and the five cases of peripheral accessory neurectomy were also performed. In two patients, the selective peripheral denervations were performed. In overall thirteen patients(93%) showed improvement in their condition. Of the eleven patients with the ventral cervical rhizotomy and spinal accessory nerve rhizotomy, nine patients(82%) improved. Five patients suffered from dysphagia or dysphonia postoperatively for several months, but one patient is having more than two years. Of these six patients, five patients had undergone the bilateral upper cervical rhizotomy and bilateral accessory nerve rhizotomy. Therefore to reduce the postoperative dysphagia or dysphonia, the authors recommend to save the unilateral cervical ventral roots or unilateral accessory nerve root. The authors also stress that the selective peripheral denervation would be the choice of operation in cases with the spasmodic torticollis because of its effectiveness and rarity of complications.

Surgical Treatment of Spasmodic Torticollis by Microvascular Decompression with Selective Dorsal Cervical Phizotomy: Case Report

A case of spasmodic torticollis in a 48-year-old man cured by micovascular decompression of the spinal accessory nerve with selective dorsal cervical rhizotomy of the first and second cervical nerves. The 11th nerve was compressed by the posterior inferior cerebellar artery originating from the vertebral artery at the C1 level. After intraoperative identification of each posterior rootlets of C1 and C2 nerves exclusively related with the involved sternocleidomastoid muscle(SCM) using the monopolar electric nerve stimulator, microvascular decompression with selective dorsal cervical rhizotomy was done using the Teflon felt and electrobipolar coagulator. The patient was significantly relieved from symptoms 1 week after operation.

Surgical Tratment of Intractable Head and Neck Pain

Surgical treatment of 24 patients with chronic intractable pain from head and neck cancer was reviewed in the study. Pain relief is not expected with conventional treatments designed to control the primary disease in advanced head and neck cancer. Effectiveness of neurosurgical procedures such as radiofrequency trigeminal rhizotomy, posterior cervical rhizotomy and medullary tractotomy for relief of intractable cancer pain is emphasized in the paper. Trigeminal radiofrequency rhizotomy is the treatment of choice for relieving the uncontrollable pain in the facial area. Trigeminal rhizotomy and cervical rhizotomy or medullary tractotomy are helpful for facial pain extending into the neck. Glossopharyngeal rhizotomy is seldom used but is useful for pain in the pharynx.