Spastic squint is a disorder characterized by twisting or paroxysmal tilting of the neck muscles. The symptoms are mild at the beginning of the disease and start slowly, with the head rotating to one side at random and the neck flexing to the other side, gradually worsening to the point of being uncontrollable, and tremors may occur when turning to position. The symptoms worsen during tension, emotional excitement and fatigue, and disappear completely when the neck and occipital area are supported during sleep. Because different neck muscle groups are involved, the onset of the spasm may be tilted to one side or tilted back, and may also manifest as a constant rotation of the neck. Repeated spasms cause pain in the neck and shoulder muscles, anxiety, insomnia, depression, and even loss of confidence in life.
Rotation type head rotates spasmodically or clonically to one side around the longitudinal axis of the body. According to whether the head is tilted to the longitudinal axis or not, there are three subtypes: horizontal rotation, backward rotation and forward flexion rotation.
The posterior tilt type has the head spasmodically or paroxysmally tilted backward with the face facing the sky.
The forward-flexed type of patients make a paroxysmal flexion of the head toward the chest.
In the lateral contracture type, the head deviates from the longitudinal axis and turns to the left or right. In severe cases, the ear and temporal region may be forced or tightened to the shoulder.
How is the responsible muscle for the rotational type determined?
1.Observe whether the sternocleidomastoid muscle is hypertrophied
2.Comparison of bilateral sternocleidomastoid and rhomboid electromyography
3.Pain point
4.Magnetic resonance of neck muscle group
Different surgical methods for different subtypes
1.Severance of the involved muscle groups
2.Simple paramedian nerve + high cervical nerve dissection Foster-Dandy
3.Microvascular decompression Janneta 1982
4.Stereotactic disruption, crestal pulpal electrical stimulation, etc.
5.paraneoplastic nerve dissection + distal electrocoagulation neural network destruction + MVD
Postoperative findings
1.MVD alone for TN (better efficacy, less complications), the disadvantage is that there are patients in whom the responsible vessels are not found intraoperatively
Average remission rate: 63%
2.Paraneoplastic neurectomy + electrocoagulation nerve network destruction Good efficacy, complications such as collapsed shoulder and nerve damage exist
Average remission rate: 65%
3. MVD + paraneoplastic nerve dissection and electrocoagulation The best results, but there are also complications such as shoulder collapse and nerve damage
Average remission rate: 85%
Treatment experience
1.Simple MVD is suitable for all kinds of rotational type and lateral contracture.
2.MVD+paraneoplastic nerve dissection electrocoagulation is suitable for the treatment of rotational type, lateral contracture 95%, and posterior supination type.
3.Parasympathetic nerve dissection electrocoagulation requires electrophysiological monitoring to control the degree of nerve destruction and avoid serious complications.
4.TN of anterior tilt type has poor therapeutic effect.