The transaxillary approach in the treatment of thoracic outlet syndrome: a neurosurgical appraisal.
OBJECTIVE
Different surgical approaches are available for the treatment of thoracic outlet syndrome (TOS). Our aim is to describe the transaxillary approach from a neurosurgical perspective, and to present the results in 15 patients.


RESULTS
Fifteen patients (6 m and 9 f; mean age 44 yrs) were treated for neurogenic TOS. Four patients (26.7 %) demonstrated a cervical rib. The rest did not show a diagnosable bony anomaly (73.3 %). Provocative tests were neurologically positive in all patients (100 %); 4 patients additionally demonstrated vascular symptoms (26.7 %). Six patients demonstrated ulnar nerve F-wave latency (40 %). The transaxillary approach was used in all patients. In three patients with cervical ribs (20 %), an additional ventral approach was utilized. 14 patients remain symptom-free at a mean follow-up period of 24 months (93.4 %). One complained of pain recurrence at nine months after surgery and was treated conservatively (2(1/2) yrs). One patient developed pneumothorax after surgery (6.7 %). Four patients reported on numbness of the lateral thoracic wall, due to stretch injury of the intercostobrachial nerve that lies along the approach corridor (26.7 %).


CONCLUSIONS
The transaxillary approach is one of several described surgical options for the treatment of TOS. It lies along a natural corridor and is non-muscle splitting. Although it requires a deep surgical corridor, the transaxillary approach allows definitive treatment of both bony and soft-tissue components causing TOS, provided the anatomical boundaries are recognized and respected. A persistent cervical rib, however, calls for an additional ventral approach. The complications are minimal and the results are predominantly acceptable.
Krishnan
K G
KG
Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden. Kartik.Krishnan@uniklinikum-dresden.de
Pinzer
Th
T
Schackert
G
G
D000328:Adult; D000768:Anesthesia, General; D001365:Axilla / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012272:Ribs / Q000473:pathology; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome