Neurogenic thoracic outlet syndrome treatment by the supraclavicular approach.

BACKGROUND

Thoracic outlet syndrome refers to compression of one or more of the neurovascular structures traversing the superior aperture of the thoracic cavity.

OBJECTIVE

A symptom-based patient-directed questionnaire was used to evaluate the outcome of the supraclavicular approach for treatment of neurogenic thoracic outlet syndrome.

PATIENTS AND METHODS

A prospective study was performed between April 2007 and October 2010. During this period, 97 patients in different age groups, with signs and symptoms of thoracic outlet syndrome, were surgically treated by the supraclavicular approach. The patients were aged between 14 and 60 years (mean 32.5 years), and the majority were female (89.69%). Surgery was performed on the left side in 52 patients and on the right side in 48, including 3 who had bilateral operations. The median follow-up was 11.2 months.

RESULTS

In 78% of the 100 operations, excellent improvement in symptoms was noted, there was partial improvement in 18%, and 4% resulted in no response.

CONCLUSIONS

First rib resection remains an important and essential step in the management of the thoracic outlet syndrome, in the absence of bony abnormalities. The supraclavicular approach can be employed with minimal morbidity and an excellent outcome.