1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas.
2Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Texas.
J Neurosurg Pediatr. 2024 Mar 1;33(5):484-495. doi: 10.3171/2024.2.PEDS23511. Print 2024 May 1.
Thoracic outlet syndrome (TOS) is a complex disorder affecting the neurovascular structures of the upper extremity as they traverse from the neck and thorax to the upper extremity. This systematic review and meta-analysis focuses on pediatric TOS, offering insights into its clinical presentation, etiology, treatment modalities, and outcomes in contrast to those reported in adult TOS.
A comprehensive search for pediatric TOS in the PubMed database using PRISMA guidelines identified 6 relevant studies published between 2008 and 2022. In total, 227 pediatric TOS cases in 216 patients were analyzed. Data categories explored for TOS in pediatric patients included study design, number of patients included, mean age and sex of patients, TOS type, laterality, bony abnormalities, time to surgery, symptoms, treatment modalities, initial surgical technique, surgical complications, percent lost to follow-up, mean follow-up period, and treatment outcome.
The results from the 6 studies of 216 patients show a distinct pattern in pediatric TOS, with a 1.84:1 female-to-male ratio, a mean age of 15.49 years, and a lower prevalence of neurogenic TOS (75%, 95% CI 0.41-0.93; I2 = 86%, p < 0.01) compared with the prevailing literature on adults (87.5%-99%). Venous and arterial TOS accounted for a higher proportion of cases in pediatric patients than in adults, challenging the traditional adult-oriented perspective. Right-sided presentations were more common, reflecting right-arm dominance in most individuals. Additionally, bony abnormalities were more common in adults (30%) than in children (10.65%). Treatments involved mixed methods, predominantly using combinations of muscle resection (95.26%), neurolysis (78.02%), and bone resection (72.41%). Patients had high rates of symptom improvement (89%, 95% CI 0.67-0.97; I2 = 85%, p < 0.01) following surgery, with improvement of symptoms ranging from slight to complete relief. Complications were infrequent (5.66%), and most patients reported positive outcomes. The limitations of this analysis include subjective diagnostic and reporting criteria for TOS given its broad range of presentations.
This systematic review and meta-analysis brings to light the distinctive characteristics of pediatric TOS and underscores the importance of recognizing these differences to ensure accurate diagnosis and effective treatment in this patient population. Further research is needed to understand the predictive value of conservative treatments, especially in pediatric TOS cases.
胸廓出口综合征（TOS）是一种影响上肢神经血管结构的复杂疾病，这些结构在从颈部和胸部穿行到上肢的过程中受到影响。本系统评价和荟萃分析侧重于儿科 TOS，旨在探讨其临床表现、病因、治疗方式以及与成人 TOS 报告结果的差异。
根据 PRISMA 指南，在 PubMed 数据库中全面检索儿科 TOS，共确定了 2008 年至 2022 年期间发表的 6 项相关研究。总共分析了 216 名患者的 227 例儿科 TOS 病例。对儿科患者 TOS 进行了研究设计、纳入患者数量、患者平均年龄和性别、TOS 类型、侧别、骨异常、手术时间、症状、治疗方式、初始手术技术、手术并发症、随访丢失率、平均随访时间和治疗结果等数据类别的探讨。
这 6 项针对 216 名患者的研究结果显示，儿科 TOS 具有明显的特征，女性与男性的比例为 1.84:1，平均年龄为 15.49 岁，神经源性 TOS 的患病率较低（75%，95%CI 0.41-0.93；I2=86%，p<0.01），与成人 TOS 的主流文献（87.5%-99%）形成鲜明对比。静脉型和动脉型 TOS 在儿科患者中的比例高于成人，这对传统的成人导向观点提出了挑战。右侧表现更为常见，反映了大多数个体中右臂的优势。此外，骨异常在成人中更为常见（30%），而在儿童中则更为常见（10.65%）。治疗方法包括多种方法，主要使用肌肉切除术（95.26%）、神经松解术（78.02%）和骨切除术（72.41%）的组合。手术后患者的症状改善率很高（89%，95%CI 0.67-0.97；I2=85%，p<0.01），症状改善程度从轻微到完全缓解不等。并发症发生率较低（5.66%），大多数患者报告了积极的结果。本分析的局限性在于 TOS 的诊断和报告标准存在主观性，因为其临床表现广泛。
本系统评价和荟萃分析揭示了儿科 TOS 的独特特征，并强调了认识这些差异的重要性，以确保在这一患者群体中进行准确的诊断和有效的治疗。需要进一步研究以了解保守治疗的预测价值，特别是在儿科 TOS 病例中。
