Microsurgical denervation at focal muscular dystonia, in torticollis patients

Abstract

Background: Surgical treatment of focal muscular dystonia, despite all achievements of modern neurosurgery, and auxiliary methods of diagnostics, continues to cause more questions, than gives answers. The main challenge for all who uses denervation techniques in treatment of spastic wryneck (SW) is accurate identification and the fullest exclusion of the dystonic muscles which take part in the formation of complex of symptoms of SW. Material and methods: 32 patients with torticollis were enrolled into the study. All enrolled patients underwent 75 microsurgical denervations of dystonic muscles, including 32 selective denervations of contrlateral sternocleidomastoid muscle, 28 selective posterior ramisectomy of C1-C6 roots (Bertrand’s procedure), 15 denervations and myotomias of dystonic muscles of omo-trapezoid triangle (DMOTT). Results: The outcome evaluation was conducted via neurological examination and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) questionnaire. The outcomes showed decrease of severe torticollis (up to 0%), severe disability decreased to 0%, light disability increased from 0% to 60.71%. DMOTT strongly affected, thus improved, the outcomes. Conclusions: Initial indicators of weight of a current of SW with torticollis decreased to zero that once again emphasize efficiency and adequacy of the interventions chosen the denervation and surgical targets. Easy severity prevailed at all patients in the remote terms of supervision – 60.71% that managed to be reached performance of DMOTT. Thus, the carried-out microsurgical interventions, in particular DMOTT, allowed us to reach positive result (in the context of decrease in weight of a course of a disease) at 100% of patients with T.