Round table discussion. Neurogenic thoracic outlet syndrome.

Abstract

The diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS) remains an area of controversy. Criteria for diagnosis are not uniform. Advanced imaging modalities such as magnetic resonance imaging (MRI) may have varying utility based on institutional expertise, availability of equipment and familiarity with protocols. The use of diagnostic scalene blocks, or botulinum toxin injection is very dependent on surgeon experience and preference.Techniques for surgical management vary among surgeons, with biases between surgical subspecialities. In the field of hand surgery, outcomes following surgical treatment of NTOS are one of the most variable, with different surgeons achieving good outcomes with routine use of either rib sparing scalenectomy or first rib resection in primary management of supraclavicular NTOS. Further high-quality studies are needed to guide surgeons on best practices for management of NTOS. In this round table discussion, a group of expert surgeons from different surgical specialties discuss areas of consensus and controversy in NTOS.