BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.

Department of Functional Neurosurgery Federal Neurosurgical Center Novosibirsk Russia

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Praha 6 Czech Republic

Department of Neurosurgery and Neurorestoration Klinikum Klagenfurt Klagenfurt am Wörthersee Austria

Department of Neurosurgery at University Hospital Center Mother Theresa Tirana Albania

Department of Neurosurgery Charité Universitätsmedizin Berlin Berlin Germany

Department of Neurosurgery CHU Liège Liège Belgium

Department of Neurosurgery Faculty of Medicine University of Belgrade Belgrade Serbia

Department of Neurosurgery Leiden University Medical Center ZA Leiden Netherlands

Department of Neurosurgery Mediclinic Parkview Hospital Dubai UAE

Department of Neurosurgery Ospedale Santa Maria della Misericordia Rovigo Italy

Department of Neurosurgery University of Cambridge Addenbrooke's Hospital Cambridge UK

Department of Peripheral Nerve Surgery Functional Neurosurgery and Pain Management Surgery Clinic for Neurosurgery University Clinical Center of Serbia Belgrade Serbia

Department of Peripheral Nerve Surgery Ospedale Civile di Faenza Local Health Authority of Romagna Faenza Italy

Division of Peripheral Nerve Reconstruction Department of Neurosurgery Tel Aviv Sourasky Medical Center Tel Aviv University Tela Aviv Yafo Israel

Peripheral Nerve Unit Department of Neurosurgery BKH Günzburg at Ulm UniversityGünzburg Germany

PeripheralNerveUnit Nord Christliches Krankenhaus Quakenbrück GmbH Quakenbrück Germany

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$a Rochkind, Shimon $u Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tela Aviv-Yafo, Israel $1 https://orcid.org/0000000295909764

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$a Thoracic Outlet Syndrome Part II: Consensus on the Management of Neurogenic Thoracic Outlet Syndrome by the European Association of Neurosurgical Societies' Section of Peripheral Nerve Surgery / $c S. Rochkind, S. Ferraresi, N. Denisova, D. Garozzo, C. Heinen, R. Alimehmeti, C. Capone, DG. Barone, A. Zdunczyk, MT. Pedro, G. Antoniadis, R. Kaiser, A. Dubuisson, W. Pondaag, T. Kretschmer, L. Rasulic, NF. Dengler

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$a BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.

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$a Ferraresi, Stefano $u Department of Neurosurgery, Ospedale Santa Maria della Misericordia, Rovigo, Italy $1 https://orcid.org/0000000251013640

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$a Denisova, Natalia $u Department of Functional Neurosurgery, Federal Neurosurgical Center, Novosibirsk, Russia $1 https://orcid.org/0000000260765262

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$a Garozzo, Debora $u Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, UAE

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$a Alimehmeti, Ridvan $u Department of Neurosurgery at University Hospital Center "Mother Theresa", Tirana, Albania $1 https://orcid.org/0000000227284061

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$a Capone, Crescenzo $u Department of Peripheral Nerve Surgery, Ospedale Civile di Faenza, Local Health Authority of Romagna, Faenza, Italy

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$a Barone, Damiano G $u Department of Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK $1 https://orcid.org/000000020091385

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$a Kaiser, Radek $u Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Praha 6, Czech Republic $1 https://orcid.org/0000000259859595

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