Thoracic outlet syndrome. Neurosurgical perspective.

Neurosurgeons have for the most part abdicated a role in thoracic outlet surgery and have left the diagnosis and treatment of these patients to thoracic, vascular, and general surgeons. We view this as unfortunate. Neurosurgeons are well-positioned to diagnose these conditions. The major source of confusion with regard to diagnosis is cervical spine disease or peripheral nerve entrapment diseases with which neurosurgeons are quite familiar. Orthopedic consultations with regard to shoulder pathology are encouraged. The supraclavicular approach to treatment is one with which most neurosurgeons will be comfortable. However, the transaxillary approach is also one which neurosurgeons should be able to master readily. Working with long instruments in deep holes is a familiar surgical environment. It should be stressed, however, that part of the reason for the controversy concerning TOS stems from the fact that the morbidity rate from the transaxillary approach is high in some centers. We believe this results from inadequate technique. Neurosurgeons with training that emphasizes a high regard for neural tissue should be able to master both approaches. Thoracic outlet syndrome is a disease that most neurosurgeons will see on a regular basis. Thus, it needs to be recognized, and patients need to be analyzed from a neurologic perspective. The differential diagnosis should be considered thoughtfully. Operative intervention by experienced surgeons in properly selected patients will yield satisfying results.