Histopathological basis for neurogenic thoracic outlet syndrome. Laboratory investigation.

Abstract

OBJECT To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. METHODS Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. RESULTS The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. CONCLUSIONS Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

DOI: 10.3171/SPI/2008/8/4/347

Cite this paper

@article{Tubbs2008HistopathologicalBF, title={Histopathological basis for neurogenic thoracic outlet syndrome. Laboratory investigation.}, author={R. Shane Tubbs and Robert G. Louis and Christopher T. Wartmann and Robert L Lott and Gina D. Chua and David R. Kelly and Cheryl Ann Palmer and Mohamadali M Shoja and Marios Loukas and Walter Jerry Oakes}, journal={Journal of neurosurgery. Spine}, year={2008}, volume={8 4}, pages={347-51} }