Neurogenic TOS in Children

Neurogenic thoracic outlet syndrome (nTOS) describes a set of disorders related to symptomatic compression of the brachial plexus as it passes through the thoracic outlet into the arm. In children, nTOS is a rare and frequently delayed diagnosis due to the difficulty of communicating symptoms with adults and healthcare providers and decreased prevalence of the syndrome compared to adult nTOS. Additionally, nTOS is an uncommon variant of pediatric thoracic outlet syndrome, which is predominantly arterial or vascular in nature. In this chapter we review the presentation, associated radiographic and exam findings, and management for pediatric nTOS. We summarize the outcomes for pediatric nTOS reported in the literature to date, and also present our institutional experience managing these challenging and uncommon patients.