الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
The surgical strategy remains controversial and variable, regarding the opitmum mode of access, which bony elements to excise and the management of the vascular and recurrent cases . objective: The aim of this study is to evaluate the results of different modalities of treatment of neurovascular compression manifestations of thoracic outlet syndrome (TOS) 0Patients and methods : This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were examined investigated treated and followed up during the period from January 2000 to May 2003. Patients were classified into two main groups. group II (Vascular TOS,15 patient ): included Patients presenting mainly with vascular manifestations. They were subdivided into two subgroups. group IIA (arterial TOS, 9 patients:with 10 limbs ) . group IIB (venous TOS, 6 patients (:and one was non thrombotic . They were treated by surgical decompression. Results: For neurogenic group : The outcome for patients treated by scalenectomy (R+ (Bcervical rib excision was excellent in 14 limbs , good in 6 limbs and fair in 2 limbs. However , the outcome for patients treated by combined scalenectomy (R+ (Bcervical rib excision in addition to first rib escision was excellent in 11 limbs . good in 4 limbs and fair in 3 limbs . For arterial group : The outcome was excellent in 8 limbs and good in 2 limbs. For venous group :Surgical decompression in the from of scalenectomy, venolysis and 1st rib excision was done for 2 patients and the outcome was good . Conservative treatment and also P.T.A. showed failure in two patients out of the five thrombotic patients (40%) . Conclusion: In patients with neurogenic TOS scalenectomy (R+ (Bcervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations.