A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome
Background: Current approaches to scalenectomy for brachial plexus decompression can cause nerve injuries in patients with neurogenic thoracic outlet syndrome (nTOS), especially when first rib resection (FRR) is performed. We describe a modified supraclavicular approach for scalenotomy that reduces...
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Language: | English |
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Elsevier
2021-09-01
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Series: | Interdisciplinary Neurosurgery |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751921001559 |
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doaj-1af32427efa9427ab95d9292ccd545f8 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Parménides Guadarrama-Ortíz Ingrid Montes de Oca-Vargas André Garibay-Gracián José Alberto Choreño-Parra César Osvaldo Ruíz-Rivero Deyanira Capi-Casillas Arturo Samuel Alpízar-Acevedo Ángel Daniel Prieto-Rivera |
spellingShingle |
Parménides Guadarrama-Ortíz Ingrid Montes de Oca-Vargas André Garibay-Gracián José Alberto Choreño-Parra César Osvaldo Ruíz-Rivero Deyanira Capi-Casillas Arturo Samuel Alpízar-Acevedo Ángel Daniel Prieto-Rivera A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome Interdisciplinary Neurosurgery Neurogenic thoracic outlet syndrome Scalenectomy First rib resection Supraclavicular approach |
author_facet |
Parménides Guadarrama-Ortíz Ingrid Montes de Oca-Vargas André Garibay-Gracián José Alberto Choreño-Parra César Osvaldo Ruíz-Rivero Deyanira Capi-Casillas Arturo Samuel Alpízar-Acevedo Ángel Daniel Prieto-Rivera |
author_sort |
Parménides Guadarrama-Ortíz |
title |
A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
title_short |
A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
title_full |
A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
title_fullStr |
A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
title_full_unstemmed |
A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
title_sort |
modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndrome |
publisher |
Elsevier |
series |
Interdisciplinary Neurosurgery |
issn |
2214-7519 |
publishDate |
2021-09-01 |
description |
Background: Current approaches to scalenectomy for brachial plexus decompression can cause nerve injuries in patients with neurogenic thoracic outlet syndrome (nTOS), especially when first rib resection (FRR) is performed. We describe a modified supraclavicular approach for scalenotomy that reduces the postoperative morbidity of nTOS patients. Methods: The patient is placed in supine position with the neck slightly extended and turned to the opposite side of the procedure. The modified incision begins above the clavicle 2.5 cm lateral to its first third, extends in medial direction, and turns upwards along the lateral edge of the sternocleidomastoid muscle (SCM) 2.5 cm from the clavicle. Skin flaps are elevated. The external jugular vein is dissected and retracted. The supraclavicular nerves and omohyoid muscle are conserved if found. The phrenic nerve is identified, dissected, and retracted. The anterior scalene muscle is divided, and the brachial plexus is freed. The clinical data and postoperative outcomes of patients that underwent surgery over the last three years were retrieved. The functionality of the arm after surgery was evaluated using the Disabilities of the Arm, Shoulder, and Hand questionnaire in Spanish (DASHe). Results: Sixteen nTOS patients received surgery with one bilateral procedure (17 procedures). Seventy-five percent were females with a median age of 53 years. Obesity and smoking were observed in 43.75% and 37.5% of patients, respectively. No postoperative complications occurred, except for one partial phrenic nerve palsy. All patients reduced their DASHe scores after surgery (mean reduction 41.09 ± 18.37). Conclusion: Our modified supraclavicular approach for scalenotomy is safe and improves outcomes in patients with nTOS, reducing the need for FRR. |
topic |
Neurogenic thoracic outlet syndrome Scalenectomy First rib resection Supraclavicular approach |
url |
http://www.sciencedirect.com/science/article/pii/S2214751921001559 |
work_keys_str_mv |
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doaj-1af32427efa9427ab95d9292ccd545f82021-07-17T04:34:20ZengElsevierInterdisciplinary Neurosurgery2214-75192021-09-0125101243A modified supraclavicular approach to scalenotomy without first rib resection for the treatment of neurogenic thoracic outlet syndromeParménides Guadarrama-Ortíz0Ingrid Montes de Oca-Vargas1André Garibay-Gracián2José Alberto Choreño-Parra3César Osvaldo Ruíz-Rivero4Deyanira Capi-Casillas5Arturo Samuel Alpízar-Acevedo6Ángel Daniel Prieto-Rivera7Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, Mexico; Corresponding author.Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, Mexico; Programa de Servicio Social en Investigación, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, Mexico; Facultad de Estudios Superiores (FES) Iztacala, Universidad Nacional Autónoma de México, Av De Los Barrios 1, Los Reyes Ixtacala, 54090 Tlalnepantla de Baz, MexicoDepartment of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, Mexico; Programa de Servicio Social en Investigación, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, Mexico; Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Av. Guillermo Massieu Helguera 239, Gustavo A. Madero, 07320 Mexico City, MexicoDepartment of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, MexicoDepartment of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, MexicoInternado Médico de Pregrado, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, MexicoInternado Médico de Pregrado, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, MexicoDepartment of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala 84, Roma Sur, 06760 Mexico City, MexicoBackground: Current approaches to scalenectomy for brachial plexus decompression can cause nerve injuries in patients with neurogenic thoracic outlet syndrome (nTOS), especially when first rib resection (FRR) is performed. We describe a modified supraclavicular approach for scalenotomy that reduces the postoperative morbidity of nTOS patients. Methods: The patient is placed in supine position with the neck slightly extended and turned to the opposite side of the procedure. The modified incision begins above the clavicle 2.5 cm lateral to its first third, extends in medial direction, and turns upwards along the lateral edge of the sternocleidomastoid muscle (SCM) 2.5 cm from the clavicle. Skin flaps are elevated. The external jugular vein is dissected and retracted. The supraclavicular nerves and omohyoid muscle are conserved if found. The phrenic nerve is identified, dissected, and retracted. The anterior scalene muscle is divided, and the brachial plexus is freed. The clinical data and postoperative outcomes of patients that underwent surgery over the last three years were retrieved. The functionality of the arm after surgery was evaluated using the Disabilities of the Arm, Shoulder, and Hand questionnaire in Spanish (DASHe). Results: Sixteen nTOS patients received surgery with one bilateral procedure (17 procedures). Seventy-five percent were females with a median age of 53 years. Obesity and smoking were observed in 43.75% and 37.5% of patients, respectively. No postoperative complications occurred, except for one partial phrenic nerve palsy. All patients reduced their DASHe scores after surgery (mean reduction 41.09 ± 18.37). Conclusion: Our modified supraclavicular approach for scalenotomy is safe and improves outcomes in patients with nTOS, reducing the need for FRR.http://www.sciencedirect.com/science/article/pii/S2214751921001559Neurogenic thoracic outlet syndromeScalenectomyFirst rib resectionSupraclavicular approach |