Long-term outcome after transaxillary approach for XXXX .

@entity1 @entity82 @entity531
BACKGROUND: Recurrence or persistence of neurologic symptoms after surgical treatment of @entity1 with @entity531 ( @entity531 ) are reported to be as high as 25%. To identify factors affecting the long-term outcome of surgical treatment of @entity1 with @entity531 , we reviewed our 20-year experience. METHODS: One hundred thirty-four transaxillary first rib resections were performed on 118 @entity1 (43 @entity1 , 75 @entity1 , mean age 38 +/- 13 years). Eighty-three operations (61.9%) were undertaken to relieve symptoms resulting from compression of the lower roots of the brachial plexus, 37 (27.6%) for compression of both lower and upper roots, and 14 (10.5%) for lower root and vascular symptoms. All @entity1 underwent a transaxillary extraperiosteal first rib resection with transection of the scalene muscles. In 73 cases (54.5%) a resection of the anterior scalene muscle was also performed. A cervical rib was removed in 28 cases (20.1%), and anomalous @entity82 adjacent to the neurovascular bundle were resected in 41 cases (30.6%). RESULTS: No major complications were observed. Of 105 @entity1 (118 procedures) followed up (mean follow-up, 99 +/- 72 months), good to excellent results were obtained in 96 cases (81.4%) and fair to poor results were recorded in 22 cases (18.6%). The presence of a long posterior first rib stump, measured from the chest x ray films, was the strongest determinant of the long-term results among the variables examined (p < 0.0001). Reoperation, consisting of neurolysis and resection of the stump, was performed in 16 @entity1 . The results were excellent in all cases at a mean follow-up of 66 +/- 46 months. Primary and secondary 10-year, actuarial freedom rates from recurrent symptoms were 80.9% and 93.1%, respectively. CONCLUSIONS: Our results suggest that the long-term outcome after surgery for @entity531 was strongly influenced by the extent of the first rib resection.
