Abstract
Spasmodic torticollis is a rare, neurologic disorder that is caused by abnormal nerve compression of the 11th cranial nerve by blood vessels or bony protrusions. It is typically treated pharmacologically and, if necessary, with surgical intervention. We report a unique case of spasmodic torticollis in a 15-year-old female that involved abnormal compression of the left 11th cranial nerve (CN) by the left vertebral artery, displaced by a hypertrophic left occipital condyle. After treatment with Botox was unsuccessful, the patient was treated with microvascular decompression and occipital condylectomy that adequately relieved the abnormal compression of CN XI. Mild symptoms persisted, and the patient underwent a partial section of the sternocleidomastoid muscle 1 year later, after which torticollis symptoms resolved.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alafaci C, Salpietro FM, Montemagno G, Grasso G, Tomasello F (2000) Spasmodic torticollis due to neurovascular compression of the spinal accessory nerve by the anteroinferior cerebellar artery: case report. Neurosurgery 47:768–771 discussion 771-762
Defazio G, Jankovic J, Giel JL, Papapetropoulos S (2013) Descriptive epidemiology of cervical dystonia. Tremor Other Hyperkinet Mov (N Y) 3
Jho HD, Jannetta PJ (1995) Microvascular decompression for spasmodic torticollis. Acta Neurochir 134:21–26
Nagata K, Matsui T, Joshita H, Shigeno T, Asano T (1989) Surgical treatment of spasmodic torticollis: effectiveness of microvascular decompression. No To Shinkei 41:97–102
Pagni CA, Naddeo M, Faccani G (1985) Spasmodic torticollis due to neurovascular compression of the 11th nerve. Case report. J Neurosurg 63:789–791. https://doi.org/10.3171/jns.1985.63.5.0789
Shiban E, Török E, Wostrack M, Meyer B, Lehmberg J (2016) The far-lateral approach: destruction of the condyle does not necessarily result in clinically evident craniovertebral junction instability. J Neurosurg 125:196–201. https://doi.org/10.3171/2015.5.JNS15176
Shima F, Fukui M, Matsubara T, Kitamura K (1986) Spasmodic torticollis caused by vascular compression of the spinal accessory root. Surg Neurol 26:431–434
Shirai W, Kitami K, Koyanagi I, Mitsumori K, Sakuragi M, Minoshima S, Nozaki M (1999) Successful microvascular decompression of spasmodic torticollis with multiple vascular compression on the course of the 11th nerve: a case report. Jpn J Neurosurg (Tokyo) 8:680–684
Sun K, Lu Y, Hu G, Luo C, Hou L, Chen J, Wu X, Mei Q (2009) Microvascular decompression of the accessory nerve for treatment of spasmodic torticollis: early results in 12 cases. Acta Neurochir 151:1251–1257. https://doi.org/10.1007/s00701-009-0455-6
Wen HT, Rhoton AL Jr, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87:555–585. https://doi.org/10.3171/jns.1997.87.4.0555
Acknowledgements
We acknowledge the research and editing support of Superior Medical Experts for this manuscript.
Funding
We received a grant from the United Hospital Foundation in support of this work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(PDF 198 kb)
Rights and permissions
About this article
Cite this article
Graupman, P., Feyma, T., Sorenson, T. et al. Microvascular decompression with partial occipital condylectomy in a case of pediatric spasmodic torticollis. Childs Nerv Syst 35, 1263–1266 (2019). https://doi.org/10.1007/s00381-019-04065-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-019-04065-8