Cervico-Thoraco-Brachial Crossing Syndrome: Results of Surgery in 5 Cases Operated on in the Thoracic and Cardiovascular Surgery Department in Senegal

<i>Introduction</i>: Cervico-thoraco-brachial outlet syndrome is a rare condition, affecting 1% of the population. It results from the compression of the vasculo-nervous structures, most often by the presence of a cervical rib or fibrous tissue. The place and importance of surgery remains debated by these authors who advocate conservative treatment. <i>Patients and methods</i>: This was a retrospective descriptive study of five patients with cervico-thoraco-brachial crossing syndrome treated in the Thoracic and Cardiovascular Surgery Department of National University Hospital Center of Fann in Senegal from January 1, 2006 to December 31, 2020, over a period of 15 years. <i>Results</i>: Five patients, aged on average 33 years (extreme 18 and 50 years), were operated on. The predominance was female (1 man and 4 women). The symptoms were neurological in all patients, with upper limb claudication (3 cases), cervico-brachialgia and paresthesias (5 cases). The right side was the most affected with 3 patients. Right supraclavicular swelling was noted in two patients. The Adson test was positive in 4 patients. No vascular manifestations were observed. The average duration of symptoms before the intervention was 4 years (Extremes: 1 and 5 years). Imaging revealed: a cervical rib in 3 patients. This was bilateral in 2 patients; and right unilateral in 1 patient. In the two other cases, it was an apophysomegaly of the 7th cervical vertebra and a fibrous dysplasia of the first left rib. The electromyogram performed in the 3 patients confirmed a C6 C7 C8 (1 case) and C6 C7 (2 cases) plexopathy. The preferred surgical approach was supraclavicular. For fibrous dysplasia of the first rib, a double sus and subclavicular approach was made. Compression was due to a cervical rib (3 cases), dysplasia of the first rib (1 case) and apophysomegaly (1 case). There was fibrous tissue (2 cases) and the anterior scalene muscle (1 case). Medical treatment and physiotherapy were instituted in all patients. This allowed us to have generally satisfactory results after an average follow-up of 8 years (2 – 15 years). <i>Conclusion</i>: cervico-thoraco-brachial crossing syndrome is rare. The most common anatomical modifications are the presence of a cervical rib or fibrous tissue. Surgery combined with physiotherapy improves the quality of life of patients. A more exhaustive multicenter study would allow a better evaluation of the syndrome.