ORIGINAL ARTICLES   

Chirurgia 2013 April;26(2):79-83

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Neurogenic Thoracic Outlet Syndrome: myth or reality? An old question with a new perspective

Landi A., Ruggeri A. G., Mancarella C., Delfini R.

Division of Neurosurgery, Department of Neurology and Psychiatry, University of Rome Sapienza, Rome, Italy

Aim: The authors describe their experience and propose an algorithm for diagnosis and treatment of neurogenic thoracic outlet syndrome (TOS) pointing out the importance of neurophysiological tests in this pathology.
Methods: Between January 2008 and January 2010, 15 cases with clinical suspect of TOS came to our observation. In all these patients were excluded other osteoarticular of muscles pathologies that could be responsible for the symptoms. All patients were selected and treated based on an algorithm we developed that has as its goal the identification of the true nTOS and its subsequent treatment.
Results: Seven cases were selected for surgical treatment, and all of them, in the postoperative period and at 1 and 5 months follow-up, experimented a complete resolution of painful symptoms with a functional improvement documented by neurophysiological tests.
Conclusion: The algorithm proposed seems to solve adequately the problem of diagnostic and therapeutic management of the nTOS syndrome, allowing a definitive diagnosis and optimal treatment result. The importance of a careful clinical and instrumental examination and of a conservative treatment at first, permits to reserve surgery for patients who could really benefit, eliminating the problems inherent to the differential diagnosis of the disease itself.