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BACKGROUND When conservative therapy for thoracic outlet syndrome (TOS) fails, scalenectomy with or without first-rib resection(FRR) is the treatment of choice. We measured pressure in the costoclavicular space(CCS) before and after FRR at time of neurogenic TOS(NTOS) release to evaluate if FRR is required to completely decompress the CCS. METHODS Using a supraclavicular exposure for anterior-middle scalenectomy with FRR, CCS pressures were measured using a balloon catheter with patient's arm in neutral anatomic position-the arm abducte