Name:
10.3171/2022.9.FOCVID2291_vid
Description:
10.3171/2022.9.FOCVID2291_vid
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/1bb55d0d-7039-47b9-b4fc-7e9f99cef490/videoscrubberimages/Scrubber_489.jpg
Duration:
T00H09M31S
Embed URL:
https://stream.cadmore.media/player/1bb55d0d-7039-47b9-b4fc-7e9f99cef490
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/1bb55d0d-7039-47b9-b4fc-7e9f99cef490/3. 22-91.mp4?sv=2019-02-02&sr=c&sig=OxPQ05YJejNaVt7iYUxL2g1jVbn4A1vnYbwy3vtWo0o%3D&st=2024-12-26T19%3A59%3A55Z&se=2024-12-26T22%3A04%3A55Z&sp=r
Upload Date:
2022-11-10T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
SPEAKER: In this operative video, we highlight the anatomy and operative steps of a selective denervation procedure for the treatment of cervical dystonia. The patient is a 41-year-old man with a 1.5-year history of spontaneously head turning to the right. Initially, the patient was able to voluntarily correct his head turning. However, over the course of time, his symptoms became more prominent.
SPEAKER: And he developed a continuous involuntary pulling sensation that would result in his head turning to the right. This sensation eventually became painful and uncomfortable. Further, while the patient was able to modulate the head turning with sensory cues, Botox and Botox variants unfortunately failed to provide any symptomatic relief. The patient was diagnosed with cervical dystonia, also known as spasmodic torticollis, by a movement disorder neurologist.
SPEAKER: On physical examination, he demonstrated a right rotational torticollis of more than 60 degrees. Additionally, his special movement disorder study showed increased activity in the right cervical paraspinal muscles and the left sternocleidomastoid muscle. Given the patient's worsening symptomatology, the patient consented to having a selective denervation procedure performed in the seated position.
SPEAKER: Compared to the standard Bertrand procedure, our modified technique omits identification of C1 branch. Eliminating the C1 nerve transection decreases operative time by not having to identify the variable anatomy of C1, and minimizes risk to the vertebral artery. We expose the posterior element of C1 and perform a myomectomy of right- sided rectus capitis posterior major and inferior oblique muscles.
SPEAKER: We also perform myectomy of the semispinalis capitus and/or splenius capitis muscles, all of which are supplying branches of C2 and C3. We also denervate the contralateral sternocleidomastoid through a small oblique incision. The procedure occurs in two stages with the first being selective denervation of the right cervical paraspinal muscles.
SPEAKER: To access the plane of denervation and myotomy/ myectomy, four muscles must first be appreciated and identified. Trapezius is the superficial- most muscle upon opening. Deep to the trapezius muscle lies the splenius capitus, followed by the semispinalis capitis muscle.
SPEAKER: Finally, semispinalis cervicis is present as the deepest muscle amongst those mentioned. Similar to opening individual chapters of the book, we deepen the dissection and identify the plane between the semispinalis capitus and semispinalis cervicis muscles.
SPEAKER: A posterior midline incision is used from the occiput to C7. Upon establishing our plane between semispinalis capitis and semispinalis cervicis muscles, we now have access to rectus capitis posterior major and inferior oblique muscles, and the medial branches of C2 through C6 dorsal rami.
SPEAKER: Myotomy of rectus capitis posterior major and inferior oblique muscles allows exposure to C1 posterior element and proximal exposure of C2 nerve, which is then divided.
SPEAKER: The medial branches of C3 through C6 dorsal rami are traced to their respective lamina and divided.
SPEAKER: Myectomy of the semispinalis capitis and/or splenius capitis muscle is performed. Further dissection deep to the semispinalis capitis in the gutter lateral to the facet joint allows exposure of these lateral branches of dorsal rami, which are then divided.
SPEAKER: The second stage of the procedure involves selective denervation and division of the left sternocleIdomastoid muscle. For this part of the procedure, we perform a sternocleidomastoid myotomy in addition to neurectomy of the spinal accessory nerve branch supplying the sternocleidomastoid muscle, taking care to avoid the spinal accessory nerve branch supplying the trapezius.
SPEAKER: A 3-cm oblique incision is planned halfway between the pinna of the ear and the turn of the trapezius using one of Langer's lines. The greater ocular nerve is identified, mobilized, and protected.
SPEAKER: Dissection 2 cm posterior to it, the sternocleidomastoid is divided, moving from superficial to deep. During this dissection the spinal, accessory nerve is identified, including its major branch to the trapezius and the several branches to the sternomastoid.
SPEAKER: Division of the sternocleidomastoid muscle is then completed, including the deep belly.
SPEAKER: Use of a disposable nerve stimulator helps confirm the accessory nerve branches. The branches to the sternocleIdomastoid are divided. And the branch to the trapezius is maintained. The patient's intraoperative and postoperative course were uncomplicated.
SPEAKER: Postoperatively, he had no pulling sensation and his head was straight. Presently, at 1.5- year follow-up, the patient continues to do exceedingly well. His head position remains straight. And he is able to turn it both ways with ease.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
