Supraclavicular approach for thoracic outlet syndrome

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Orthopedic Surgery

Background:

• Thoracic outlet syndrome (TOS) and iatrogenic brachial plexus injuries pose significant clinical challenges.
• The transaxillary approach is a common surgical method for first rib resection, but can lead to recurrent TOS or iatrogenic injuries.

Purpose of the Study:

• To evaluate the efficacy of the supraclavicular approach for treating primary TOS, recurrent TOS, and iatrogenic brachial plexus injuries.
• To compare surgical outcomes with non-operative management for TOS.

Main Methods:

• Retrospective analysis of 33 patients (34 plexuses) with TOS undergoing evaluation and treatment.
• Surgical intervention in 12 plexuses, including primary TOS, recurrent TOS, and iatrogenic brachial plexus injury.
• Non-operative management in 22 plexuses, with 11 serving as a control group.

Main Results:

• 100% excellent or good results in patients undergoing primary (n=5) or secondary surgery for recurrent TOS (n=4).
• 54% of non-operatively treated patients (n=11) experienced some benefit.
• Reoperation for iatrogenic injuries yielded good to fair results, with all patients pain-free.

Conclusions:

• The supraclavicular approach allows precise assessment and safe treatment of thoracic inlet abnormalities.
• This approach facilitates complete first rib resection and nerve reconstruction with minimal neurovascular risk.
• Supraclavicular exploration is a valuable technique for managing complex TOS and brachial plexus injuries.