Abstract

Objective

We examined the role of botulinum toxin (BTX) injections of anterior scalene (AS) and pectoralis minor (PM) muscles in patients undergoing surgery for neurogenic thoracic outlet syndrome (NTOS). We hypothesized that symptomatic improvement from BTX injections correlates with favorable long-term response to surgery for NTOS.

Materials and methods

This Health Insurance Portability and Accountability Act compliant study was approved by the institutional review board and prior informed consent requirement was waived. We retrospectively analyzed prospectively acquired data in NTOS patients who underwent sonographically guided chemodenervation of AS and PM using BTX type A followed by scalenectomy and first rib resection. Overall responses to BTX injections and surgery were recorded after each procedure. Statistical analyses were performed to determine correlation between responses to BTX injections and surgery.

Results

In 157 patients, 178 BTX injections followed by surgery were identified (114 females; mean age 38 ± 13 years). Responders and non-responders to BTX injections and surgery had similar preoperative symptom duration and age (P > 0.14). Better response to BTX injections correlated positively with better response to surgery (P = 0.003), persisting after adjustment for age, gender, and symptom duration (P = 0.03). A high proportion of responders to BTX injections also responded to surgery (positive predictive value of 99%), and BTX injections showed high specificity (90%). BTX injections were moderately sensitive (66%) and accurate (67%) to determine surgical response and had low negative predictive value (14%).

Conclusion

Response to BTX injections correlates positively with long-term surgical outcome in subjects with NTOS, potentially playing an important role in patient management.

中文翻译：

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超声引导下神经源性胸廓出口综合征患者的肉毒杆菌毒素注射：与手术结果的关系

摘要

目的

我们检查了肉毒杆菌毒素（BTX）注射前斜角肌（AS）和胸小肌（PM）在接受神经源性胸廓出口综合征（NTOS）手术的患者中的作用。我们假设BTX注射的症状改善与NTOS手术的良好长期反应相关。

材料和方法

此健康保险可携带性和责任法案合规性研究已获得机构审查委员会的批准，并且无需事先知情同意。我们回顾性分析了NTOS患者的前瞻性采集数据，这些患者接受了超声引导下使用BTX A型进行AS和PM的化学除神经，然后进行了角膜切除术和第一次肋骨切除术。每次手术后记录对BTX注射和手术的总体反应。进行统计分析以确定对BTX注射的反应与手术之间的相关性。

结果

在157例患者中，确定了178例BTX注射后进行了手术（114例女性；平均年龄38±13岁）。BTX注射和手术的反应者和非反应者具有相似的术前症状持续时间和年龄（P > 0.14）。对BTX注射的更好反应与对手术的更好反应呈正相关（P = 0.003），在调整了年龄，性别和症状持续时间后仍持续（P = 0.03）。对BTX注射的反应者中，很大一部分对手术也有反应（阳性预测值为99％），而BTX注射显示出很高的特异性（90％）。BTX注射对确定手术反应具有中等敏感性（66％）和准确度（67％），阴性预测值低（14％）。

结论

NTOS患者对BTX注射的反应与长期手术结局呈正相关，可能在患者管理中发挥重要作用。