[Surgical aspects of the cervicothoracobrachial outlet]

Poitevin has described six levels of entrapment of the brachial plexus observed in the thoracic outlet syndromes. The diagnosis remains difficult due to the association between the vascular and neurological symptoms. The EMG study and the ultrasonic examination orient in a significant manner the diagnosis of the level of the lesions in the interim of progress by magnetic resonance imaging. Our surgical experience shows that the cervical approach without resection of the first rib makes it possible to treat entrapment of the roots C5-C6-C7 and the only entrapment of the roots C8-TH1 without vascular lesion. The vascular syndrome requires resection of the first rib by the axillary surgical approach described by Ross or by the supra- and infraclavicular approach described by Cormier. This surgery requires a strict indication and a precise technical realization.