Complications and clinical benefits of the combined supra- and infraclavicular approach in neurogenic thoracic outlet syndrome
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: The objective of this study was to analyze whether the combined supra- and infraclavicular approach for neurogenic thoracic outlet syndrome (nTOS) increases postoperative complications and to determine whether its anatomical advantages translate into improved clinical outcomes without increasing morbidity when compared to isolated supraclavicular approaches. Methods: A retrospective study of 69 procedures performed for nTOS between 2015 and 2024 by a single neurosurgeon. Surgical approaches, intraoperative findings, postoperative complications, and clinical outcomes were analyzed. Results were compared between the combined and isolated supraclavicular approaches using Chi-square testing and logistic regression models. Results: = 0.545). All complications were transient, most commonly phrenic nerve palsy (7.2%) and superficial wound infection (5.8%). No permanent brachial plexus or vascular injuries occurred. The combined approach provided significantly better exposure of both proximal and distal compression zones, enabling more complete decompression, which was reflected in a higher rate of clinical improvement (82% vs. 69% in isolated approaches). Conclusion: Although the combined approach presents a numerically higher complication rate, the difference is not statistically significant, and all complications were transient. Its superior anatomical exposure and higher rate of clinical improvement support the combined approach as a safe and advantageous surgical option for patients with suspected multilevel nTOS compression.
Source: Surgical Neurology International
Institution: Hospital Regional Universitario de Málaga
Language: English
Topic: Peripheral Nerve Disorders
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7128861513