Surgical techniques: Operative decompression using the supraclavicular approach for NTOS

Abstract

Supraclavicular exposure offers the benefits of complete scalenectomy, complete brachial plexus neurolysis, and excellent exposure for resection of the mid- and posterior first rib (and any other bony or soft tissue abnormalities), making it an excellent approach for the surgical treatment of patients with neurogenic thoracic outlet syndrome (TOS). Nonrandomized and noncontrolled data have not demonstrated any difference in outcomes when compared to transaxillary exposure in patients operated on for this problem, at least in the hands of experts using their preferred approach. In properly selected patients, an excellent-to-good outcome should be expected in approximately 80 % of patients using the supraclavicular approach for neurogenic TOS, and the recurrence rate may be lower than with other approaches. Temporary phrenic and/or long thoracic nerve dysfunction is not rare, occurring in between 5 and 10 % of patients, and pneumothorax is temporary and innocuous. With experience this exposure is an excellent solution in patients with neurogenic TOS, and has the flexibility to be readily applicable to the other forms of TOS.