Endoscopy for neurogenic thoracic outlet syndrome: effectiveness and safety assessments

Thoracic outlet syndrome (TOS) is a complex and multifactorial condition characterized by the compression of neural, arterial, or venous structures. Traditional surgical approaches use open dissections presenting substantial recurrence rates of 15-20%. This study aimed to explore the safety and efficacy of endoscopic surgery for neurogenic TOS treatment, given the evolution of surgical techniques toward minimally invasive approaches.

A study was conducted involving 30 patients who were resistant to conservative treatment, presented with objective images of neurogenic compromise at the brachial plexus, and underwent brachial plexus endoscopy. Outcomes were assessed using the Visual Analog Scale for Pain and the Quick Disabilities of the Arm, Shoulder, and Hand score, both pre- and postsurgery, with a minimum follow-up of 24 months postoperatively.

The results indicated a significant improvement in symptoms. All patients experienced clinical improvement and resumed their normal activities. The average Visual Analog Scale for Pain score decreased from 5.57 ± 2.18 before surgery to 1.30 ± 1.02 after surgery (P < .01). The average Quick Disabilities of the Arm, Shoulder, and Hand score decreased from 41.89 ± 12.80 before surgery to 5.39 ± 6.74 after surgery (P < .01). There were no requirements for surgical reintervention, and no patients suffered neurological injuries or other complications.

The results of this study affirm that the endoscopic technique evaluated is both an effective and safe treatment modality for neurogenic TOS. It offers the advantages of low morbidity and expedited recovery, making it particularly suitable for patients with neurogenic TOS, including those with a low vascular component. Nevertheless, for cases where vascular compression is pronounced and/or patient have already presented previous vascular repercussions such as thrombosis, open surgical techniques for rib resection remain as the gold standard, therefore should be considered as a primary treatment.