title: Surgical treatment of thoracic outlet syndrome: effect and results of surgery.
abstract: BACKGROUND
  Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience.
  
  
  METHODS
  Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity.
  
  
  RESULTS
  Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient.
  
  
  CONCLUSIONS
  Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey. abalci@dicle.edu.tr
authors.forename: Akin Eraslan
authors.initials: AE
authors.lastname: Balci
authors.forename: Tansel Ansal
authors.initials: TA
authors.lastname: Balci
authors.forename: Omer
authors.initials: O
authors.lastname: Cakir
authors.forename: Sevval
authors.initials: S
authors.lastname: Eren
authors.forename: Mehmet Nesimi
authors.initials: MN
authors.lastname: Eren
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D010292:Paresthesia / Q000209:etiology; D011877:Radionuclide Imaging; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014459:Ulnar Nerve / Q000503:physiopathology; D018608:Ultrasonography, Doppler