Use of a Posterior Paramedian Subscapular Approach in Pathologic Processes in the Upper Aperture Region

Shevelev I., Shtok .

Burdenko Research Institute of Neurosurgery, Moscow, Russia


There were 10 cases (males and females) with clinical manifestations of the upper aperture syndrome (UAS), watched in different pathologic processes in this area.

The research goal was introduction of a method, which would allow to perform the most complete approach to the upper aperture region with the smallest risk of intraoperative complications. UAS diagnosis was carried out with applying electrophysiologic, X-ray and neurovisualizing methods of examination. Despite different etiology (posttraumatic syndrome of the upper aperture, postoperative syndrome of the upper aperture, tumor of a vertebral body, tumors of the brachial plexus), a clinical picture was similar. The only difference lied in a greater or smaller degree of lesions of the brachial plexus and, in particular, its primary trunks.

Results. The results demonstrated, that the above approach was indicated, when a pathologic process involved proximal segments of primary trunks of the brachial plexus. The main advantage was a broad access to initial segments of primary trunks of the brachial plexus (in particular, their intraforaminal part), a lung apex, an area of musculi scalenus posterior and medius. Surgical tactics was dependent on etiology and severity of a lesion of anatomic structures in the upper aperture region. The operation resulted in elimination of a cause of UAS and persistent regression of clinical symptoms.

Conclusion. Thus, a posterior subscapular paramedian approach is a method of choice in scarry-and-adhesive processes, posttraumatic pain syndromes and neoplasms in the upper aperture region, when proximal segments of primary trunks of the brachial plexus are involved.