Presentation, management and outcome of surgically managed pediatric thoracic outlet syndrome

• Published in: Child's nervous system 2022-10, Vol.38 (10), p.1949-1954
• Main Authors: Murthy, Nikhil K., Kabre, Rashmi, Corkum, Kristine S., Behbahani, Mandana, Thirunavu, Vineeth, Karras, Constantine L., Alden, Tord D.
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Article
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-022-05592-7

Purpose Thoracic outlet syndrome (TOS) is a rare disorder involving compression of the brachial plexus, subclavian artery, and subclavian vein. There is a paucity of data for this pathology’s surgical treatment within pediatrics. The objective of this study is to explore the presentation, management, and outcome of pediatric TOS. Methods A retrospective chart review was conducted for 44 patients at a single institution undergoing surgery for TOS. Data was collected on demographics, pre- and postoperative factors, and outcomes. Results Forty-four patients underwent 50 surgeries (8 bilaterally). The average age was 15.5 years with 72% female. The most common symptoms were numbness (72%) and pain (66%), with a normal exam in 58%. The average symptom duration prior to surgery was 35.2 months. A supraclavicular approach was performed in all patients, with anterior scalene section (90%), rib resection (72%), neurolysis (92%), and intraoperative EMG (84%) commonly used. Two patients had a lymphatic leak. All patients reported subjective improvement of preoperative symptoms of numbness (26%), pain (22%), and weakness (6%). Differences between vTOS ( n  = 9) and nTOS ( n  = 35) included higher preop swelling ( p