Artikel
Diagnosis, classification, and therapy of thoracic outlet syndrome – a consensus approach by the EANS section of peripheral nerve surgery
Diagnose, Klassifikation und Therapie des Thoracic Outlet Syndroms: ein Consensus Ansatz der EANS Sektion für Periphere Nervenchirurgie
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Autoren
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Nora F. Dengler
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Shimon Rochkind
- Sourasky Medical Center - Tel Aviv University, Department of Neurosurgery – Division of peripheral nerve reconstruction, Tel Aviv, Israel
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Stefano Ferraresi
- Ospedale Santa Maria della Misericordia, Department of Neurosurgery, Rovigo, Italien
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Natalia Denisova
- Federal Neurosurgical Center Nemirovicha, Department of Functional Neurosurgery, Novosibirsk, Russische Föderation
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Debora Garozzo
- Mediclinic Parkview Hospital, Department of Neurosurgery, Dubai, Vereinigte Arabische Emirate
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Christian Heinen
- Christliches Krankenhaus Quakenbrück, Department of Neurosurgery, Quakenbrück, Deutschland
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Maria Teresa Pedro
- Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Sektion Periphere Nerven, Günzburg, Deutschland
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Gregor Antoniadis
- Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Sektion Periphere Nerven, Günzburg, Deutschland
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Lukas Rasulic
- University Clinical Center of Serbia, Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management, Belgrade, Serbien
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
Text
Objective: To systematically review the body of evidence and reach a consensus among neurosurgeons experienced in thoracic outlet syndrome (TOS) regarding anatomy, diagnosis, classification, and therapy. Although numerous articles have been published not only on the classification of TOS, but also on diagnostic standards, timing and type of surgical intervention, there still remains some controversy due to the lack of level 1 evidence. So far, attempts to generate uniform reporting standards have not yielded conclusive results.
Methods: A systematic literature search on PubMed / MEDLINE was performed on February 13, 2021, yielding 2853 results. Abstracts were screened and classified. Recommendations were developed in meetings held among members of the European Association of Neurosurgical Societies (EANS) section of peripheral nerve surgery online on February 10, 2021 and on December 16, 2021. Refinements were processed according to the Delphi consensus method.
Results: Six randomized controlled trials (on surgical, conservative, and injection therapies), four “guideline” articles (on imaging and reporting standards), five observational studies (on diagnostics, hierarchic designs of physiotherapy vs. surgery, quality of life outcomes), and six meta-analyses were identified. The authors established 18 statements regarding anatomy, diagnosis, and classification as well as 14 statements regarding timing and type of therapy of TOS. Due to spatial limitations in this abstract, we would like to present, as an example, that in case of initial diagnosis of neurogenic TOS type 1 we state that anterior supraclavicular decompression with intraoperative neuromonitoring and optic magnification may be promptly conducted.
Conclusion: Due to the lack of level 1 evidence, consensus statements on anatomy, diagnostics, classifications, and therapy of TOS from experts of the section of peripheral nerve surgery of the EANS were developed using the Delphi method. Our consensus statements may help for individualized decision making. Further work on reporting standards, prospective data collections, TOS therapy, and long-term outcome is necessary.
