Surgical treatment of thoracic outlet syndrome in pediatrics
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In brief
In brief
Retrospective review of 9 pediatric TOS patients (median age 14) treated surgically between 2001-2020 demonstrates that the transaxillary Roos operation is safe and effective for children failing conservative management. All patients achieved symptom resolution with minimal complications and excellent long-term outcomes over follow-up ranging from 4 months to 20 years.
Written by the GCMD Library team from the article.
Aim
: Thoracic outlet syndrome (TOS) is a condition that occurs when the cervical neuro-vascular bundle becomes compressed at one of the three narrow areas of the thoraco-cervico-axillary region. Conservative management is the first line of treatment. Patients who do not respond to conservative management should be treated surgically. The aim of this review is to present our experience with the surgical management of TOS in pediatric patients.
Methods
: We retrospectively reviewed the outcomes of all patients with TOS operated at our Hospital between 2001 and 2020. We collected all demographic data, clinical features, imaging data, type of operation performed, intraoperative findings, complications and recurrence.
Results
: We operated 9 patients within the study period. The median age at surgery was 14 (7 to 17) years. A transaxillary approach was used in 7 patients and a supraclavicular approach in 2. There was only one minor intraoperative complication (violation of the pleural space). There were no postoperative complications. The median length of stay was 3 (2 to 4) days. All patients were extubated in the operating room. Two patients developed symptoms on the contralateral side. One of these underwent a successful contralateral transaxillary Roos operation. The follow-up was 4 months to 20 years. All patients are asymptomatic.
Conclusion
: We believe that the Roos operation is a safe and effective treatment with excellent long-term outcomes for children with TOS that fail conservative management.