Microvascular decompression with partial occipital condylectomy in a case of pediatric spasmodic torticollis

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 to check access.

Fig. 1
Fig. 2

References

  1. 1.

    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

    CAS  PubMed  Google Scholar 

  2. 2.

    Defazio G, Jankovic J, Giel JL, Papapetropoulos S (2013) Descriptive epidemiology of cervical dystonia. Tremor Other Hyperkinet Mov (N Y) 3

  3. 3.

    Jho HD, Jannetta PJ (1995) Microvascular decompression for spasmodic torticollis. Acta Neurochir 134:21–26

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    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

    CAS  PubMed  Google Scholar 

  5. 5.

    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

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    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

    Article  PubMed  Google Scholar 

  7. 7.

    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

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    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

    Article  Google Scholar 

  9. 9.

    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

    Article  PubMed  Google Scholar 

  10. 10.

    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

    Article  CAS  PubMed  Google Scholar 

Download references

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

Affiliations

Authors

Corresponding author

Correspondence to Eric S. Nussbaum.

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

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

Keywords

  • Spasmodic torticollis
  • Torticollis
  • Microvascular decompression
  • Accessory nerve