Supraclavicular surgical approach for thoracic outlet syndrome: 10 years of experience

Abstract

AIm: Symptoms of thoracic outlet syndrome (TOS) may be vascular, neurological or combined symptoms involving both. Treatment of TOS is generally conservative. Surgical treatment is required when radiological results indicate anatomical abnormality. This study aims to present the surgical outcomes of TOS patients treated with supraclavicular approach via microsurgery. mATERIAl and mEThods: 41 patients with thoracic outlet syndrome were rewieved retrospectively. The pain was determined using both on visual analogue scale (VAS) and Oswestry score both in the preoperative and postoperative period. All patients underwent electromyography including brachial plexus, ulnar and median nerves. Computed Tomography (CT) angiographic examination was applied dynamically with required manoeuvres.REsulTs: Post-op VAS scores were recorded as 0.8 for the arm, 0.6 for the shoulder and 0.5 for the neck, while pre-op VAS scores were 6.3 for the arm, 6.0 for the shoulder and 5.2 for the neck. Post-op Oswestry disability index (ODI) average was found as 14,2, while this figure was 67,4 during the pre-operative period.CoNClusIoN: Accurate patient selection is imperative for increasing the success of TOS surgery. Microscopic TOS surgery yields satisfactory results with smaller incision, safer surgery and a lower rate of complication.KEywoRds: Thoracic outlet syndrome, Supraclavicular approach, Surgery ÖZ AmAÇ: Torasik çıkış sendromu (TÇS) vasküler, nörolojik ya da her iki yapıya bası sonucu ortaya çıkabilir. TÇS tedavisi genellikle konservatiftir. Radyolojik olarak tespit edilen anomali durumunda cerrahi tedavi gereklidir. Bu çalışmanın amacı, supraklaviküler yol ve mikroşirürjkal teknikle ameliyat edilen TÇS tanılı hastaların cerrahi sonuçlarını bildirmektir. yÖNTEm ve GEREÇlER: TÇS nedeni ile opere edilen 41 hasta geriye dönük olarak incelendi. Hastaların klinik durumları görsel ağrı skoru (VAS) ve Oswestry skorlaması (ODI) ile cerrahi öncesi ve sonrası değerlendirildi. Hastaların tamamına cerrahi öncesi brakial pleksus, ulnar ve median sinirleri kapsayacak şekilde elektromyografik inceleme ve gerekli manevralar yapılarak dinamik bilgisayarlı tomografik anjiografileri (BTA) yapıldı.BulGulAR: Cerrahi öncesi kol, omuz ve boyun ağrısı VAS değerleri sırasıyla 6,3; 6,0; 5,2 iken cerrahi sonrası kol, omuz ve boyun ağrısı VAS değerleri sırasıyla 0,8; 0,5; 0,5 olarak tespit edildi. ODI cerrahi öncesi ortalama 67.4 iken bu değer cerrahi sonrası 14.2'e indi. soNuÇ: TÇS için doğru hasta seçimi cerrahi başarı şansını artıracaktır. Mikroskop eşliğinde yapılan TÇS daha küçük açılım, daha emniyetli cerrahi ve daha az komplikasyon oranı ile ile yüz güldürücü sonuçlar vermektedir.ANAhTAR sÖZCÜKlER: Torasik çıkış sendromu, Supraklaviküler yaklaşım, Cerrahi

Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics

“…When performed in patients with clearly localized compression, this approach can provide significant improvement in pain and disability. 6,23 If the compression is caused by a distal structure, an infraclavicular or transaxillary approach can be used. 11 The transaxillary approach is most commonly used to treat vascular TOS and less often for nTOS.…”

Reporte de Caso Clínico y discusión de tema: síndrome del opérculo torácico

“…Transaxilar: Considerada por muchos la mejor opción quirúrgica descrita por Ross y Owens (2,4,18,21,22), pues encamina a resecar la estructura ósea que constituye la raíz del problema (4), la primera costilla por lo cual tiene mayor tasa de éxito (92%), además de tener un buen resultado estético. Sin embargo, es la que mayor tasa de complicaciones reporta (3,4,17). Además de ser una vía de difícil acceso para reparos vasculares, requiere buena experiencia para evitar lesiones de estructuras vasculares y nerviosas vecinas (3,5,22).…”

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“…[8][9][10] Surgical treatment, on the other hand, is reserved for those people who remain in severe and refractory chronic pain for longer than three months, which compromises the patients' quality of life. 11 Thus, considering chronic pain as a disabling symptom for the neurogenic TOS patient, the purpose of this study is to evaluate the quality of life of patients who underwent supraclavicular surgery, and to evaluate whether there was an improvement in the patients' degree of pain.…”