Surgical techniques: Operative decompression using the supraclavicular approach for neurogenic thoracic outlet syndrome

Supraclavicular exposure for the surgical treatment of patients with neurogenic thoracic outlet syndrome (TOS) allows the surgeon to perform complete anterior and middle scalenectomy, complete brachial plexus neurolysis, and first rib resection, as well as pectoralis minor tenotomy, within a readily visualized operative field. A step-wise description of supraclavicular decompression is outlined in this chapter, based on sequential visualization of six "critical views" and a thorough, flexible, and safe approach. Potential complications and the reported results of treatment are briefly reviewed, indicating that 85-90% of patients with neurogenic TOS can expect substantial improvement in symptoms and function following supraclavicular decompression, with long-term recurrence rates less than 5% during follow-up. With expertise and experience, supraclavicular decompression offers the surgeon an excellent, versatile and safe approach in patients with neurogenic TOS and it has the flexibility to be applicable to all other forms of TOS and intraoperative contingencies.