Vascular compression of the spinal accessory nerve (cranial nerve XI) by the vertebral artery or other vessels has been proposed as a cause of Spasmodic Torticollis (ST). The neurovascular compression is thought to irritate the brainstem and spinal cord centers that control neck movement. The resultant hyperexcitability of these nerves leads to the neck spasms of Spasmodic Torticollis (ST). Microvascular decompression (MVD) surgery aims to alleviate the neurovascular compression and thereby target the cause of the disorder. The procedure does not injure the nerve roots, brainstem or the spinal cord. Few results have been published, although surgical cure rates of over 50% are reported.

      The surgery is performed through a posterior incision and exposure of the lower brainstem and upper spinal cord. Vessels that are abnormally contacting the affected nerves are moved to new positions and held with small shredded Teflon® felt implants. ST symptoms may immediately start to disappear after MVD surgery, or gradually fade away after a few months to two years. Complications related to this surgery are rare at centres with expertise in MVD surgery.

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