Taira T, Hori T
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
Stereotact Funct Neurosurg. 2001;77(1-4):40-3. doi: 10.1159/000064590.
Most of spasmodic torticollis is classifical as cervical dystonia and the treatment of choice is chemical or surgical denervation. There are two major procedures for surgical denervation, intradural ventral rhizotomy and extradural peripheral neurotomy (Bertrand procedure). Both have advantages and disadvantages. The authors have modified these procedures to minimize the complications, with unilateral intradural ventral rhizotomy of C1 and C2, extradural denervation of the C3-C6 posterior rami, and contralateral peripheral sectioning of the branches of the spinal accessory nerve to the sternocleidomastoid muscle. 30 patients underwent this modified operation (Group A) and the results were compared with those in a matched control group of 20 patients who underwent the traditional Bertrand procedure (Group B). Only one patient in Group A showed a sensory deficit in the C2 area, while all the patients in Group B had C2 sensory disturbance. Pre- and postoperative rating scores did not differ between the two groups. The intraoperative blood loss was significantly smaller in Group A. Compared with the traditional Bertrand's operation, our procedure involves fewer complications and significantly less intraoperative blood loss.
大多数痉挛性斜颈被归类为颈部肌张力障碍，其首选治疗方法是化学或手术去神经支配。手术去神经支配有两种主要术式，即硬膜内腹侧神经根切断术和硬膜外周围神经切断术（伯特兰手术）。两者都有优缺点。作者对这些术式进行了改良以尽量减少并发症，方法是对C1和C2进行单侧硬膜内腹侧神经根切断术，对C3 - C6后支进行硬膜外去神经支配，并对副神经至胸锁乳突肌的分支进行对侧周围切断。30例患者接受了这种改良手术（A组），并将结果与20例接受传统伯特兰手术的匹配对照组患者（B组）进行比较。A组仅1例患者出现C2区域感觉缺失，而B组所有患者均有C2感觉障碍。两组术前和术后评分无差异。A组术中失血量明显较少。与传统的伯特兰手术相比，我们的手术并发症更少，术中失血量也明显更少。
