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. 2023 Apr-Jun;14(2):144-148.
doi: 10.4103/jcvjs.jcvjs_153_22. Epub 2023 Jun 13.

Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach

Filippo Gagliardi  1 , Marzia Medone  1 , Leone Giordano  2 , Silvia Snider  1 , Martina Piloni  1 , Edoardo Pompeo  1 , Francesca Roncelli  1 , Luca Ruffino  1 , Pietro Mortini  1
Affiliations

Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach

Filippo Gagliardi et al. J Craniovertebr Junction Spine. 2023 Apr-Jun.

Abstract

Aims and objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal area due to the bulk generated by the anterior scalene muscle (ASM). Over the years, alternative techniques for ASM surgical management have been developed, which are still today a matter of debate. Most popular include ASM scalene complete section (SCS) and ASM medial detachment (SMD). Authors describe an innovative, minimally invasive muscle section technique, the anterior selective scalenectomy (ASS), which reduces the risk of iatrogenic morbidity and optimizes exposure of periforaminal area in anterolateral cervical routes.

Materials and methods: A laboratory investigation was conducted. Technique was applied in a surgical setting, and an illustrative case was reported.

Results: ASS is a quick and easy technique to perform. It allows optimization of surgical visibility and control on the periforaminal area in the cervical anterolateral corridor. It respects muscle anatomy and vascularization, favoring functional recovery and management of peri-operative pain; it reduces the risk of morbidity on phrenic nerve and pleura. Considering the minimally invasive nature of the technique, it allows for a slightly more limited exposure compared to traditional techniques while ensuring optimal surgical maneuverability on the target area.

Conclusions: ASS represents an effective and safe alternative to traditional ASM section techniques for the exposure of periforaminal area in anterolateral cervical routes. It is indicated in case of lesions with paravertebral development and minimal intraforaminal component in the C3-C6 segment.

Keywords: Brachial plexus; cervical anterolateral approach; cervical paravertebral tumors; scalenectomy; ventral supraclavicular approach.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1
Figure 1
Schematic drawing showing anatomic principles of selective scalenectomy for periforaminal exposure. (a) Coronal view. (b) Axial view. AN - Accessory nerve, ASM - Anterior scalene muscle, CA - Carotid artery, CL - Clavicle, IT - Inferior trunk, JV - Jugular vein, LC - Longus colli, MSM - Median scalene muscle, MT - Medial trunk, NR - Nerve root, PN - Phrenic nerve, PSM - Posterior scalene muscle, SCM - Sternocleidomastoid muscle, ST - Superior trunk, VN - Vagal nerve
Figure 2
Figure 2
Intraoperative view (a) with correspondent schematic drawing (b). ASM - Anterior scalene muscle, CA - Carotid artery, JV - Jugular vein, PN - Phrenic nerve, R - Retractor, SCM - Sternocleidomastoid muscle, ST - Superior trunk, TB - Tumor bed
Figure 3
Figure 3
Preoperative MRI (a), postoperative MRI (b), and picture of the patient (c). ASM - Anterior scalene muscle, JV - Jugular vein, MSM - Median scalene muscle, T - Tumor, TB - Tumor bed, MRI - Magnetic resonance imaging
See this image and copyright information in PMC

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