Thoracic Outlet Syndrome Part I: Systematic Review of the Literature and Consensus on Anatomy, Diagnosis, and Classification of Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies' Section of Peripheral Nerve Surgery

Abstract

BACKGROUND:Although numerous articles have been published not only on the classification of thoracic outlet syndrome (TOS) but also on diagnostic standards, timing, and type of surgical intervention, there still remains some controversy because of the lack of level 1 evidence. So far, attempts to generate uniform reporting standards have not yielded conclusive results.OBJECTIVE:To systematically review the body of evidence and reach a consensus among neurosurgeons experienced in TOS regarding anatomy, diagnosis, and classification.METHODS:A systematic literature search on PubMed/MEDLINE was performed on February 13, 2021, yielding 2853 results. Abstracts were screened and classified. Recommendations were developed in a meeting held online on February 10, 2021, and refined according to the Delphi consensus method.RESULTS:Six randomized controlled trials (on surgical, conservative, and injection therapies), 4 “guideline” articles (on imaging and reporting standards), 5 observational studies (on diagnostics, hierarchic designs of physiotherapy vs surgery, and quality of life outcomes), and 6 meta-analyses were identified. The European Association of Neurosurgical Societies’ section of peripheral nerve surgery established 18 statements regarding anatomy, diagnosis, and classification of TOS with agreement levels of 98.4 % (±3.0).CONCLUSION:Because of the lack of level 1 evidence, consensus statements on anatomy, diagnosis, and classification of TOS from experts of the section of peripheral nerve surgery of the European Association of Neurosurgical Societies were developed with the Delphi method. Further work on reporting standards, prospective data collections, therapy, and long-term outcome is necessary.

Thoracic Outlet Syndrome Part II: Consensus on the Management of Neurogenic Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies’ Section of Peripheral Nerve Surgery

“…1 A group discussion about the findings of the literature and a possible structure of recommendations was held in an online meeting of the European Association of Neurosurgical Societies (EANS) section of peripheral nerve surgery on December 16, 2021. Statements were developed and EANS section members who fulfilled the following inclusion criteria received the questionnaire: “>5 years of specialist practice after board certification; membership in the EANS peripheral nerve surgery section; TOS experience >30 cases” 1 ( Supplementary Material 1 , http://links.lww.com/NEU/D469). In the process, 15 experts with a total of 286 years (mean 19.1 years ±10.6, range 7 to 36 years) of postcertification experience in a total of 2835 TOS cases (mean 189 cases ± 204.0 range 30-700 cases per surgeon) participated (see Table 2 for individual TOS experience of participating neurosurgeons).…”

“…[1][2][3][4][5][6] Three prospective observational studies present outcomes after therapeutic interventions (please also see Table 2 in TOS part I). 1,[7][8][9] All studies are single-center studies. There were no highquality data on recurrent TOS.…”

“…Five RCTs reported on management strategies in TOS (please also see Table 1 in TOS part I). [1][2][3][4][5][6] Three prospective observational studies present outcomes after therapeutic interventions (please also see Table 2 in TOS part I). 1,[7][8][9] All studies are single-center studies.…”

“…Recently, we introduced a new nTOS subclassification (Table 1) together with a consensus statement regarding anatomy, classification, and diagnosis among neurosurgeons experienced in TOS treatment. 1 We now aim to present a systematic review on therapeutic aspects of nTOS with special focus on nonsurgical treatment, timing, and type of surgery to guide patient counseling and to support treatment decisions. Because of a lack in level 1 evidence, we present an expert consensus among experienced TOS neurosurgeons.…”

Peripheral nerve surgery in Serbia: “Think global, act local” and the privilege of service

“…He served as the founder and founding president of the European Association of Neurosurgical Societies (EANS) Section for Peripheral Nerve Surgery (2017–2021). Being the most proactive EANS Section, it has organized the most webinars of all Sections, published a systematic review and consensus papers on thoracic outlet syndrome ( Dengler et al., 2022 ), and derived a preliminary European nerve surgery curriculum.…”