Abstract:

Thoracic outlet syndrome ( TOS) is a complex entrapment syndrome of the brachial plexus in the thoracic outlet, consisting various vague symptoms and signs. Surgical treatment for TOS is controversial due to its surgical technique-demands and high complications. From 1993 and 2001, after a 8-year experience in brachial plexus exploration, 35 highly selected patients ( positive in clinical examinations, reconfirmed by neurologist and failed in conservative treatment ) with 38 TOS were treated by surgery at Chang Gung Memorial Hospital by the same surgeon. Three were operated bilaterally at different time. Five TOS patients due to fractured clavicle were excluded. All were performed by supraclavicular and/or subclavicular approach by a 10cm C-curved neck incision with apex toward the sterno-clavicular junction. Upper, middle, and lower trunks of the brachial plexus were identified and protected. Nearly total removal of the scalene anterior muscle and resection of the first rib and cervical rib (if presented) with help of Kellison punch forcept were our surgical procedure. Thirty-five TOS ( 92%) had excellent to good results. Only three TOS in three patients had fair result: two had further cervical spine laminectomy for abnormal vein compression in the cord, one due to recurrent lung apex tumor ( thoracic neurofibroma ). Complications were minimal: two pleural effusion, one lymph leakage, and 4 temporal motor weakness or numbness in the operated limb. There was no case with recurrence of symptoms and signs, except the case of the recurrent lung apex neurofibroma. Surgical decompression by this improved technique is re-appraised. This modified surgical improved technique is approved well and kept confidently utilizing for the treatment of the intractable TOS.