[Neurovascular compression syndrome in the upper thoracic aperture region: diagnosis and surgical treatment].

Abstract

Neurovascular compression syndrome (NVCS) in the region of the upper thoracic aperture (UTA) occurs due to significant compression of the vascular-nervous bundle (VNB) in narrow anatomical spaces, which are represented by an interscalene space, costoclavicular space and area under the pectoralis minor tendon. Based on the data of traditional clinical and instrumental research methods, it is not always possible to accurately determine the nature and level of damage to the vascular-nervous bundle (VNB), that is often caused by variability of anatomical organization of the peripheral nervous system.

Objective: To identify and describe the specific clinical features of NVCS in the region of UTA and propose an informative instrumental method of diagnosis for development of the optimal surgical treatment algorithm.

Material and methods: The study included 130 patients with signs of compression of vascular-nervous structures in the region of UTA: 83 (63.8%) women and 47 (36.2%) men. Age of patients ranged from 18 to 75 years (mean age was 44.59±12.48 years). The study algorithm included evaluation of clinical and instrumental research methods. All patients underwent MSCT angiography of UTA structures for determination of the surgical treatment tactics. A total of 110 patients were operated, and 121 surgical interventions were performed using three types of surgical access.

Results: The main neurological symptom was a pronounced pain syndrome, which covered the entire shoulder girdle, cervico-occipital region with distribution along the anterior surface of the chest and interscapular region with radiation to the upper limb. Pain syndrome had a diffuse and constant nature, changing the intensity depending on the position of the body and physical loads. Specific trigger points were also identified. Clinical signs of circulatory disorders have been observed in the area of subclavian artery (n=54), subclavian vein (n=31) and vertebral artery (n=43). In 90 patients with MSCT angiography, 110 X-ray macro features of compression (bone, muscular, fibrous and vascular abnormalities) were identified.

Conclusion: Evaluation of specific clinical symptoms of VNB compression and use of data from MSCT angiography of structures of UTA and BCA allow to determine the level and nature of damage to the vascular-nervous complex and choose the optimal surgical treatment method.