Thoracic outlet syndrome (TOS) is a complex of the symptoms which are related with neurovascular compression in the thoracic outlet area. The manage ment of the TOS are achieved by conservative or non- operative methods such as physiotherapy and/or surgical interventions. We reviwed the patients who were managed surgically because of TOS. in our department, we managed surgically twenty-eight patients with TOS in the last ten years. The causes of the compression were the soft tissue structures in the cases (37.7 %), and the osseous structures in 18 cases (64.3 %), The compression of the brachial plexus was noted in the rate of 85.7 percent. The vascular complications of the TOS were arterial thrombosis or thromboembolism, venous thrombosis, and Ray- naud’ s phenomenon (14.3 %). Paresthesia (100 %) and pain (67.8 %) were the clinic manifestations which were noted frequently. The supraclavicular approach was used in the involvement of the upper brachial plexus C5-7 (57 %), and the transaxillary one was used in the lesions of lower brachial plexus (i.e, C8-11) or in the compression of the osseous structures (42.9 %). Postoperative complications were incisional hematoma (3.5 %), transient power loss (3.5 %) and causalgia (3.5 %). The postoperative results were good in 32.1 %, fair in 57.2 % and poor 10.7 %, Recurrent TOS developed in two cases (7 %), and was noted pseudorecurrence in one case. The management of the TOS is surgical one in the selected cases, and improvement is over the rate of 80 %.