Redo surgery for neurogenic thoracic outlet syndrome is useful

Goeteyn, Jens; Sanden, Lieke van der; Pesser, Niels; Houterman, Saskia; Sambeek, Marc R.H.M. van; Nuenen, Bart F.L. van; Teijink, Joep A.W.

doi:10.1016/j.jvs.2022.03.863

Cited by 7 publications

(9 citation statements)

References 36 publications

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“…The ratio of male to female patients was described by Leffert as approximately 1 to 3.5 [4]. Similar numbers supporting this approximation can be found in the demographic data of several clinical studies [5][6][7].…”

Section: Introductionsupporting

confidence: 83%

“…By the time surgical intervention is considered, they will have seen an average of 6.7 doctors [14]. However, after surgery, symptoms recur or persist in 5 to 30 percent of patients [7].…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative scarring or an incomplete resection of the proximal segment of the first rib are the main reasons for recurrent and residual NTOS [7,[24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

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The Morphology of the Dorsal Part of the First Rib in Neurogenic Thoracic Outlet Syndrome Patients: A Retrospective Clinical Study

Fox,

Lassner,

Prescher

2024

JPM

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Background: The recurrence or persistence of symptoms after thoracic outlet decompression (TOD) in patients with neurogenic thoracic outlet syndrome (NTOS) is not uncommon. Some authors have shown significantly better clinical outcomes in patients who underwent TOD with exarticulation of the first rib compared to a group who underwent TOD with preservation of the dorsal portion of the first rib. Several other case series have shown significant improvement after redo surgery with removal of the dorsal first rib remnant. This indicates the importance of the dorsal part of the first rib in NTOS. However, radical exarticulation may not always be necessary. In this study, we tried to answer the question of whether there is a morphological difference in the dorsal part of the first rib in NTOS patients that might help in the diagnosis and treatment of NTOS. Methods: We used the CT data of 21 NTOS patients who underwent TOD surgery and measured the dorsal part of the first rib, then compared them with a quota sample. Results: We found no difference in the dorsal part of the first rib between NTOS patients and the quota sample in our data. Conclusions: As there was no detectable difference, we were not able to use these data to help decide whether exarticulation is necessary in achieving adequate symptom relief. Therefore, we advocate exarticulation of the first rib when TOD is indicated.

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Section: Introductionsupporting

confidence: 83%

“…By the time surgical intervention is considered, they will have seen an average of 6.7 doctors [14]. However, after surgery, symptoms recur or persist in 5 to 30 percent of patients [7].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Morphology of the Dorsal Part of the First Rib in Neurogenic Thoracic Outlet Syndrome Patients: A Retrospective Clinical Study

Fox,

Lassner,

Prescher

2024

JPM

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“…Persistent or recurrent NTOS can result after incomplete excision of anatomic anomalies and/or the first rib. [20][21][22] Incomplete resection of bone anomalies may cause symptoms persistence or recurrence, either due to direct compression or because the prior surgical site acts as a fixed, rigid adhesion point for the scar tissue. 21 The leading causes of insufficient compression were difficulty reaching the decompression area or damage to neurovascular structures.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Neurogenic Thoracic Outlet Syndrome: Exploring the Efficacy of the Posterior Intermuscular Approach in Cases Involving Bone Anomalies

Tolga,

Nilay,

Umut

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: This article presents a cohort study focusing on neurogenic thoracic outlet syndrome (NTOS) caused by bone anomalies in the cervicothoracic region, specifically the extraforaminal area and the scalene triangle. Our aim was to contribute to understanding NTOS diagnosis and management, particularly in patients with bone anomalies, and to highlight the potential benefits of the posterior intermuscular approach as a surgical option in this particular patient group. METHODS: We retrospectively evaluated the patients who underwent surgery for NTOS with accessory ribs or an elongated cervical vertebrae 7 (C7) transverse process (n = 9). Patients' clinical data, preoperative neurophysiological tests, cervical computed tomography (CT) scans, CT angiography, and postoperative cervical CT scans were reviewed. A single experienced surgeon used the posterior intermuscular approach on all patients. The accessory rib and/or elongated C7 transverse process and fibrous bands were removed; C7, C8, and T1 branches of the plexus were decompressed; and neurolysis was performed. Quality of life, a functional outcome, was measured by using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and pain was measured using visual analog scale scores. RESULTS: The mean follow-up time after surgery was 7 months (range: 4-10 months). Before surgery, the mean DASH score was 55.8 ± 5.6. At the 3- and 6-month postoperative evaluations, the mean DASH scores decreased to 15.7 ± 5.8 and 15.4 ± 5.7, respectively. The mean visual analog scale score was 8.2/10 before surgery and decreased to 2.4/10 and 2.1/10 at the 3- and 6-month postoperative evaluations, respectively. All patients experienced good or excellent recovery at the 3- and 6-month postoperative evaluations. CONCLUSION: Cervicothoracic extraforaminal area may be the primary site of nerve compression in NTOS, and posterior decompression using the posterior intermuscular approach can provide efficient access to extraforaminal nerve roots.

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“…For instance, we mention a case from 2021 concerning a middle-third clavicle fracture which is the most frequent type of fracture of this bone that, yet, exceptionally complicates with HS [ 17 ]. Also, tumours (like osteocondroma), traumas or surgical interventions at the level of first rib might cause the condition [ 18 , 19 ]. Cranio-cervical artery dissection, usually spontaneously arising or after minor trauma causes stroke in young adults, but, also, HS in 25% of cases [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Redo surgery for neurogenic thoracic outlet syndrome is useful

Cited by 7 publications

References 36 publications

The Morphology of the Dorsal Part of the First Rib in Neurogenic Thoracic Outlet Syndrome Patients: A Retrospective Clinical Study

The Morphology of the Dorsal Part of the First Rib in Neurogenic Thoracic Outlet Syndrome Patients: A Retrospective Clinical Study

Surgical Management of Neurogenic Thoracic Outlet Syndrome: Exploring the Efficacy of the Posterior Intermuscular Approach in Cases Involving Bone Anomalies

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

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