Scoville W B, Bettis D B
Acta Neurochir (Wien). 1979;48(1-2):47-66. doi: 10.1007/BF01406020.
Motor tics of the head and neck, especially hemifacial spasm and spastic torticollis, are the substance of this paper. Forty-six cases are presented, and surgical techniques are described. In hemifacial spasm the intracranial neurovascular lysis of Jannetta is a valid operation with the best results to date but has a 7 1/2% risk of unilateral deafness. The extracranial submastoid partial section of Scoville is completely safe and gives excellent results, but there is a probability of mild to moderate return of the spasm in one to two year's time. In spastic torticollis the accepted radical operation consists of bilateral anterior rhizotomy of the upper three roots plus bilateral spinal accessory nerve section in the neck. A tragic complication of this operation has recently been observed by ourselves, Sweet, and Hamlin. This complication is bilateral infarction of the medulla (bilateral Wallenberg's syndrome). This has also been reported as occurring following chiropractic manipulations. For this reason the writer does limited unilateral sectioning of the spinal accessory nerve in the neck and resection of the upper third of the sternomastoid muscle, as a first stage procedure, in those cases in which rotation of the neck is the principal symptom, before doing the radical operation. Safeguards to prevent this complication include preoperative vertebral arteriography and preservation of both motor and sensory radicular arteries under magnification and maintenance of adequate neck support during the early postoperative days.
头颈部的运动性抽搐，尤其是半面痉挛和痉挛性斜颈，是本文的主题。本文报告了46例病例，并描述了手术技术。对于半面痉挛，詹内塔的颅内神经血管松解术是一种有效的手术，是目前效果最好的，但有7.5%的单侧耳聋风险。斯科维尔的颅外乳突下部分切断术完全安全，效果极佳，但一到两年后痉挛有轻度至中度复发的可能性。对于痉挛性斜颈，公认的根治性手术包括双侧切断上三根前根加双侧颈段副神经切断术。最近，我们自己、斯威特和哈姆林都观察到了这种手术的一种悲惨并发症。这种并发症是双侧延髓梗死（双侧瓦伦贝格综合征）。也有报道称这种情况在整脊手法治疗后发生。因此，对于那些以颈部旋转为主要症状的病例，作者在进行根治性手术之前，作为第一阶段手术，在颈部进行有限的单侧副神经切断术并切除胸锁乳突肌上三分之一。预防这种并发症的措施包括术前椎动脉造影，在放大倍数下保留运动和感觉神经根动脉，并在术后早期维持适当的颈部支撑。
