Computed tomography-guided reoperation for neurogenic thoracic outlet syndrome.

[thoracic outlet syndrome]

Persistent or recurrent symptoms after surgical treatment for neurogenic thoracic outlet syndrome (nTOS ) is a problem commonly encountered by high -volume referral centers . The mechanical etiology patterns at reoperation include (1 ) inadequate previous rib resection , (2 ) rib regrowth , (3 ) scar tissue formation , or (4 ) intact scalene muscle . Reoperative TOS surgery has significant potential morbidity , and therefore , careful patient selection and meticulous planning are required . This study evaluated the utility of multidetector computed tomography (CT ) in the differential diagnosis of patients with recurrent or persistent nTOS .A retrospective record review was performed of a nTOS referral practice of patients treated from 2003 to 2012 to focus on patients reoperated on for recurrent or persistent symptoms . In 2003 , a dedicated high -resolution multidetector TOS CT protocol was established to assist in clinical decision making and reoperative planning . A single designated radiologist interpreted all CT images . Imaging , patient clinical characteristics , interventions , and outcomes were reviewed .The study group included 20 reoperations for recurrent (n Â = 15 ) or persistent (n Â = 5 ) symptoms . Mean age was 35 Â years , and 60 % of redo cases were in women . Preoperative CT imaging demonstrated the following anatomic patterns : inadequate previous rib resection in 5 (25 %), rib regrowth in 5 (25 %), scar tissue formation in 10 (50 %), and intact scalene muscle in 3 (15 %). Operative findings concurred with preoperative imaging in 85 % of patients . There were no neurovascular injuries and no major complications . At a mean follow-up of 43 Â months , improvement or resolution of symptoms was significant in nine patients (45 %), moderate in seven (35 %), and minimal in four (20 %).Recurrent /persistent nTOS is an often-vexing problem with challenging solutions . These results demonstrate the utility of a TOS protocol CT scan in providing correlative objective findings and in assisting with reoperative planning . Positive radiographic findings that correlate with patient symptoms inform the decision to reoperate .

Diseases
Validation

Diseases presenting "rib resection" symptom

dedifferentiated liposarcoma

thoracic outlet syndrome

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