Dramatical Recovery of Thoracic Outlet Syndrome After Surgery: Case Report

Year 2019, Volume: 3 Issue: 2, 193 - 196, 23.08.2019

Oktay Aslaner

https://doi.org/10.30565/medalanya.536556

Abstract

Thoracic Outlet Syndrome (TOS) is a complex of clinical symptoms characterized by the compression of vascular and neurogenic structures which are localized within the thoracic outlet region. There is no gold standard diagnostic criterion for TOS and the anamnesis and physical examination are important tools for the diagnosis. Supportive and differential examinations are often electromyography (EMG), direct cervical radiography, and neck MRI. Priority in treatment is conservative treatment consisting of medical treatment and physical therapy. Last surgical option is the surgical treatment consisting of the resection of the first costa and cervical costa, and the incision of the scalenus anterior and scalenus medius muscles. It has been reported that TOS resulting from the compression of vascular structures, improved in a very short period of time after surgery, while in TOS resulting from the compression of neurogenic structures the improvement occurs between 6 months and 1 year on average. We performed 1st costa resection on a TOS case with the compression of neurogenic structures . Contrary to the literature, complaints of our case disappeared completely within 1 week. One month after the operation, EMG findings returned to normal. 

Keywords

Thoracic outlet syndrome, neurogenic symptoms, Surgery

Torasik Outlet Sendromunda Cerrahi Sonrasi Dramatik İyileşme: Olgu Sunumu

Abstract

Torasik Outlet Sendromu (TOS); torasik çıkımdaki vasküler ve nörojenik yapıların basıya maruz kalmasıyla karakterize klinik semptomlar kompleksidir. TOS da altın standart bir tanı kriteri yoktur. Tanıda anamnez ve fizik muayenenin önemi büyüktür. Destekleyici ve ayırt edici tetkikler sıklıkla elektromiyolografi, direk servikal grafi ve boyun MR ıdır. Tedavide öncelik medikal tedavi ve fizik tedaviden oluşan konservatif tedavilerdir. Son seçenek 1.kostanın ve varsa servikal kostanın çıkarılması ve skalen anterior ve skalen medius kaslarının kesilmesinden oluşan cerrahi tedavidir. Vasküler yapılara bası sonucu gelişen TOS da cerrahi tedavi sonrasında düzelme bulguları çok kısa sürede ortaya çıkarken, nörojenik yapılara bası sonucu oluşan TOS bulguları ortalama 6 ay ile 1 yıl arasında düzelmektedir. Biz nörojenik yapılara bası bulgularıyla kliniğe yansıyan TOS vakamıza literatürde en fazla rastlanan transaksiller girişim yöntemiyle 1. kosta rezeksiyonu uyguladık. Literatürden farklı olarak vakamızın şikayetleri 1 hafta içerisinde tamamen kayboldu. Operasyondan 1 ay sonra ise EMG bulguları tamamen normale döndü. 

Keywords

Torasik outlet sendromu, nörojenik semptomlar, cerrahi

References

• 1. Harold C, Urschel Jr. Thoracic Outlet Syndrome. în: Shields TW. editör. General Thoracic Surgery. 5th ed. Philadelphia: Saunders CO; 1999. p. 571-79.
• 2. Urschel H.C.:Thoracic Outlet Syndrome: Reoperation in International Trends in: Grillo H.C. editör. General Thoracic Surgery. Majör Challenges. lth.ed. Philadelphia: W.B. Saunders CO; 1987 p. 374-380.
• 3. Baue A.E., Urschel H.C.,Razzuk M.A.. Thoracic Outlet Syndrome in: Baue A.E., Geha A.S., Hammond G.L., Laks H.,Naunheİm K.S. editors. Glenn’s Thoracic and Cardiovasculer Surgery. 5th. ed. Prentice-Hall International Inc.East Norwalk. Connecticut; 1991. p. 495-507.
• 4. Sanders RJ, Smith R. Dignosis studies. İn: Richard J. Sanders. J.B. editors. Thoracic Outlet Syndrome. A Common sequela of neck injuries. Pennsylvania: Lippincott Company; 1991. p.71-85.
• 5. Smith FCT, Winterborn RJ. Thoracic outlet syndrome. Surgery. 2019;37(2):112-118. https://doi.org/10.1016/j.mpsur.2018.12.010
• 6. Machanic BI, Electrophysiological Assessment and Nerve Function in: Illig KA. editör. Thoracic Outlet Syndrome. London: Springer-Verlag; 2013. p. 127-133
• 7. Illig KA, Donahue DM. NTOS for the Primary Care Team: When to Consider the Diagnosis? İn: Illig KA,editör. Thoracic Outlet Syndrome. London: Springer-Verlag; 2013. p. 31-35
• 8. Kahraman C, Akçalı Y, Oğuzkaya F, Taşdemir K, Bilgin M, Şahin A. Torasik outlet kompresyon sendromunda cerrahi tedavi. GKDC Dergisi. 1997;5:300-305.
• 9. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. Journal of Vascular Surgery. 2007;46(3):601-04 https://doi.org/10.1016/j.jvs.2007.04.050
• 10. Sanders RJ, Pearce WH. The treatment of thoracic outlet syndrome. A comparison of different operations. Journal of Vascular Surgery 1989;10(6):626-34. https://doi.org/10.1016/0741-5214(89)90005-0