{"id":"78167b29-6ea8-4bba-b3cd-0ecec9093fa8","slug":"selective-peripheral-neurotomy-for-multifocal-spasticity-two-dimensional-operative-video","title":"Selective peripheral neurotomy for multifocal spasticity: Two-dimensional operative video","authors":["Dong Wang","Yongjian Jin","Guilherme Henrique Weiler Ceccato","Yonghui Jiao"],"abstract":"Background: Spasticity is a disabling condition, usually present as a manifestation of upper motor neuron syndrome. It can be diffuse, focal, or multifocal, and the treatment should be individualized considering the factors as type, cause, progression over time, as well as joints and muscles functionality. Case Description: We present the case of a 35-year-old female patient developing a left-sided multifocal spasticity following the bleeding of an arteriovenous malformation 5 years ago. Unfortunately, the patient presented progressive symptoms over the years which were refractory to different medical treatments. Considering no muscle contractures, no definitive joint deformities, the existence of antagonist muscles functionality, as well as a multifocal scenario, we performed a selective peripheral neurotomy to the most affected nerves. Under the guidance of intraoperative neurophysiological monitoring and employing microsurgical techniques, we approached nerve branches of the musculocutaneous and median nerve in the upper limb, and the tibial nerve in the lower limb. During the procedure, it was already possible to see changes in the electroneuromyography and reduction of muscle tone. The patient presented improvement of symptoms in the 1st days following the procedure, with a significant decrease in abnormal flexor tone of the affected muscles. Conclusion: Careful preoperative neurological examination is essential to plan the most accurate surgical strategy, and rehabilitation adherence is mandatory for a favorable long-term outcome. Patient consented to the procedure and publication of this operative video. 0:07 - Clinical presentation 1:13 - Rationale for the procedure 1:23 - Risk of the procedure and its potential benefits 1:27 - Alternatives and why they were not chosen 1:28 - Surgical strategy 1:45 - Key surgical steps 9:04 - Disease background 9:08 - A brief review of clinical and imaging outcome. The Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. https://doi.org/10.25259/SNI_746_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/general-neurosurgery.png","publishDate":"2025-09-26T00:00:00.000Z","doi":"10.25259/SNI_746_2025","categories":["General Neurosurgery","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/78167b29-6ea8-4bba-b3cd-0ecec9093fa8/pdf"}