Thoracoscopy-assisted first rib resection for the treatment of thoracic outlet syndrome caused by fibrous dysplasia: A report of two cases

Abstract

Abstract. This study reports two rare cases of thoracic outlet syndrome (TOS) caused by fibrous dysplasia of the first rib. Two patients, aged 19 and 29 years old, were admitted with TOS in the lower trunk of the brachial plexus caused by an inflated first rib. In these two cases symptoms included hypoesthesia of the anterior medial aspect of the forearm and two fingers in the ulnar side, and progressive weakness of the upper limbs. Surgery was required to resect the first rib. Transaxillary and supraclavicular excisions were challenging to perform due to the involvement of the subclavian vasculature and brachial plexus. Thoracoscopy was used in these cases in order to peel the pleura off the first rib and facilitate resection by the supraclavicular approach. None of the patients exhibited nerve or vascular complications following the surgery.

Surgical treatment of osteochondroma on the first rib by double clavicle osteotomy and internal fixation with a reconstruction plate: A case report and literature review

“…From the literature review, various surgical approaches to the first rib have been proposed, including thoracotomy, supraclavicular, infraclavicular, the transaxillary route for removing anterior tumors, and the interscapulovertebral route for removing posterior tumors [ 6 , 7 ]. Several techniques used for surgical exposure of first rib tumors are as follows: clavicular osteotomy, resection of the anterior chest wall, a thoracoscopy-assisted approach, excision of the medial two-thirds of the clavicle and acromioclavicular disarticulation [ 3 , [8] , [9] , [10] ]. Both, size of the mass and mobilization of the clavicle are key factors in determining the appropriate surgical approach [ 10 , 11 ].…”

A primer for the student joining the general thoracic surgery service tomorrow: Primer 2 of 7

“…The patient’s position varies with the operation performed but typically involves placing the patient in the supine position and elevating the operative shoulder with a small pad or folded blanket to maximize exposure. 35 , 39 Additionally, there are several approaches to first rib resection including supra- and infraclavicular, transaxillary, and minimally invasive video-assisted techniques. 40 The broad steps of the procedure are listed below.…”

Thoracic Outlet Syndrome Caused by Fibrous Dysplasia of the First Rib

“…TOS způsobený fibrózní dysplazií prvního žebra je velmi vzácnou nosologickou jednotkou, do roku 2016 bylo popsáno jen sedm případů, proto není možno stanovit optimální management léčby (1,2,6,7,9,11).…”

“…Naposled v roce 2016 byl popsán případ 19letého muže s poruchou citlivosti ulnární strany pravé ruky a 29letého muže s poruchou citlivosti a progresí slabosti levé ruky. U obou případů bylo resekováno první žebro thorakoskopicky asistovaným supraklavikulárním přístupem (11). Ve všech případech bylo popsáno zlepšení symptomatologie.…”