A Decade of Excellent Outcomes after Surgical Intervention in 538 Patients with Thoracic Outlet Syndrome

New Diagnostic and Treatment Modalities for Neurogenic Thoracic Outlet Syndrome

“…This institution demonstrated a 91% surgical success rate in those who were offered operative management [20]. This institute selects patients with nTOS who are refractory to an eight-week course of physical therapy and responsive to anterior scalene muscle blocks with Botox or lidocaine for surgical intervention [1]. In contrast, another major referral center for TOS implements an approach in which nTOS patients are deemed appropriate for operative management only if they demonstrate symptomatic improvement with 8–16 weeks of physical therapy.…”

“…The mean operative time in this study was 163 ± 39 min, which is longer than the average operative time of the other previously-established surgical approaches [28]. Given that most experienced centers routinely performing first rib resection with traditional approaches via the supraclavicular or transaxillary incision have a much shorter length of hospital stay of one day post-operatively and that these approaches require only a single incision, implementation of the above techniques has not yet occurred on a large scale [1]. …”

“…This approach aims to decrease the risk of pneumothoraces, a complication that is observed at a rate of 10–23% of patients undergoing transaxillary first rib resection [1,29]. One series of 22 patients undergoing first rib resection with the endoscopic-assisted transaxillary approach for better visualization of the operative field reported no complications associated with vascular, neural or pleural damage with success rates comparable to those of the traditional transaxillary approach [30].…”

“…It is the most common of the three subtypes of TOS representing 95% of overall TOS occurrences, with women aged 20–40 being the primary population affected, yet it is the most controversial for several reasons [1,2]. With nTOS, unlike arterial and venous TOS, diagnosis is largely clinical and subjective in nature, with no definitive imaging or diagnostic studies available to confirm its presence.…”

Cervical Rib and Thoracic Outlet Syndrome

“…In a series of patients who underwent FRR for all of the three forms of the TOS: neurogenic, venous, and arterial, during a period of 10 years, excellent outcomes were obtained. An increasing role for surgical intervention in children was reported [77].…”