SUPRACLAVICULAR REOPERATION FOR NEUROGENIC THORACIC OUTLET SYNDROME

Thirty-nine reoperations in 38 patients with recurrent symptoms of neu rogenic thoracic outlet syndrome were performed by the supraclavicular approach. Scarring around the brachial plexus was the primary cause i n 59% of procedures, whereas in 41% of reoperations residual osseous a nd soft tissue anomalies were identified in the supraclavicular area a nd were responsible for recurrence of symptoms. Anterior and middle sc alenectomy and neurolysis of the brachial plexus were the procedures o f choice. Complications included pleural entry (62%), lymphatic leak ( 10%), brachial plexus and phrenic nerve injuries (5% each), and long t horacic and recurrent laryngeal nerve palsies (3% each). The initial s uccess rate for secondary operations was 74%, and long-term success at 18 months was 45%. Patients who had demonstrable anatomic anomalies h ad better short- and long-term results than had patients with scarring alone. Compared with the results of primary operations for neuogenic thoracic outlet syndrome, reoperations led to a longer hospital stay a nd inferior long-term results. Supraclavicular decompression allows ma ximal exposure of the brachial plexus and identification and correctio n of causative soft tissue and bony anomalies. For these reasons we re commend this as the approach of choice in both primary and secondary o perations for neurogenic thoracic outlet syndrome.