Surgical treatment of dystonia

Dystonia, defined as a disorder of sustained muscular contraction leading to abnormal postures and twisting movements, has evoked both fascination and frustration from neurosurgeons for decades. Many procedures have been tried for the many types of dystonia, including myectomies, selective denervation, decompression, ablative lesions, and deep brain stimulation. Success of these surgical approaches must be weighed against the relatively bleak outcome for generalized dystonia and the striking efficacy of botulinum toxin injection in focal dystonia. The modern armamentarium includes selective peripheral denervation for spasmodic torticollis and thalamic or pallidal stimulation, and the neurosurgeon must choose a procedure based on reports of its past success. The author reviews these reports of the procedures currently available for the treatment of dystonia.