Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS.

Background Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection. Case Report We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site. Primary tumor resection was achieved via a combination of surgery, adjuvant radiation therapy, and imatinib. All recurrences were successfully resected and confirmed via pathology to be ectopic chordoma. Discussion Ectopic recurrence of cervical chordoma is rare and lung is the most common site of distant spread. Chordoma recurrence in skeletal muscle is particularly rare, with only 10 cases described in the literature. A plausible mechanism of distant metastatic disease in chordoma patients suggests that tumor cells escape the surgical tract via a combination of cytokine release, vasodilation, and microtrauma induced during resection. Conclusion Cervical chordoma with ectopic recurrence in skeletal muscle has not been previously described in the literature. Skull base surgeons should be aware of the phenomenon of chordoma ectopic recurrence in the absence of local recurrence.

The two histologic subtypes of craniopharyngiomas (CPs), papillary and adamantinomatous, harbor mutually exclusive mutations of BRAF V600E and CTNNB1, respectively. Studies suggest that subtotal resection (STR) plus adjuvant radiation therapy (XRT) may result in similar progression-free survival (PFS) as gross total resection (GTR). We hypothesized that STR ± XRT and GTR result in similar PFS for both BRAF and β-catenin–mutated CPs.Patients who were surgically treated for a primary CP between 2001 and 2023 at a single institution were included. Immunohistochemical studies were performed retrospectively using BRAF and β-catenin antibodies. Patients with missing immunohistochemistry (IHC) diagnosis were excluded. Differences in PFS for STR ± XRT and GTR groups were assessed with a log-rank test, stratified by BRAF and β-catenin IHC status.A total of 77 patients with CP were screened. IHC data were available for 50 patients; 20 had a BRAF mutation, and 30 had a β-catenin mutation. Among BRAF patients, 11 underwent GTR; 9 had STR, and 5 had adjuvant XRT. Among β-catenin patients, 14 underwent GTR; 16 had STR, and 6 had adjuvant XRT. For BRAF patients with GTR, the median PFS was not reached; for BRAF patients with STR ± XRT, the median PFS was 150 days (p < 0.01, log-rank test). For β-catenin patients with GTR, the median PFS was 1,813 days; for β-catenin patients with STR ± XRT, the median PFS was not reached (p = 0.80, log-tank test).Both GTR and STR ± XRT seemed to offer similar PFS outcomes only for patients with β-catenin–mutated CP. For patients with BRAF-mutated CP, a greater extent of resection was significantly associated with prolonged PFS.