Carpal tunnel syndrome is the most common of compression neuropathies and in the structure of upper limb tunnel syndromes. Surgical treatments are diverse and clarifications of the indications for the implementation of each of them will allow to individualize the behavior of the intervention. Purpose of work – clarify the determining factors for classical and advanced minimally invasive intervention in carpal tunnel syndrome; evaluate the effectiveness of such an approach. We observed 52 patients with carpal tunnel syndrome with unsuccessful conservative treatment; electroneuromyographic and ultrasound signs of gross changes in the structures of the carpal canal. There were 19 men and 33 women (36.5% and 63.5%, respectively). In 28 patients (group 1), surgical intervention was performed according to the classical technique from an incision of 5.0-5.5 cm. Surgical treatment in 24 patients was carried out from an access of up to 2.5 cm (minimally invasive intervention). They made up the 2nd group. The dynamics of the indicators of the Boston BCTQ questionnaire and the visual analogue scale indicated a greater severity of symptoms, functional and pain disorders of the hand after 4 weeks in the extended access group compared with the minimally invasive access group with similar indicators before the intervention. However, by 3 and 6 months, the results converge and practically do not differ. Similar good results indicate the correctness of the chosen tactics and the validity of an individual approach in determining the nature and scope of the intervention.

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Carpal tunnel syndrome CTS most often occurs among compression neuropathies and tunnel syndromes of the upper limb. The existence of many surgical treatment methods indicates the need for an individual approach in their implementation. The purpose of the paper is to clarify the determining factors for the best intervention in terms of the scope and to evaluate the eff ectiveness of proposed principles. Materials and methods. We observed 52 patients with carpal tunnel syndrome with unsuccessful conservative treatment; electroneuromyographic and ultrasound signs of gross changes in the structures of the carpal tunnel. There were 19 men and 33 women (36.5% and 63.5%, respectively). In all patients, the intervention started with a 2.5 cm access and revision of the carpal tunnel structures. In cases where their gross anatomical changes were verifi ed, the access was expanded to 5-5.5 cm and the intervention was performed not only on the carpal ligament but also on altered structures using microsurgical techniques and optical magnifi cation. Results. The dynamics of indicators of the Boston BCTQ questionnaire and the VAS were in full agreement with the degree of anatomical and functional disorders. This trend persisted after 4 weeks, and by the 3rd and 6th months, the results were close and, in the end, practically did not diff er. Conclusions. Carpal tunnel syndrome is the most common of compression neuropathies and upper limb tunnel syndromes. Surgical treatments are diverse. Clarifi cations of the indications for using each of them will allow personalizing the intervention.