Surgical intervention remains the mainstay of therapy for the treatment of neurogenic thoracic outlet syndrome (NTOS). Evaluation of results and long term outcomes following surgical treatment has been difficult because there are no reliable, standardized or objective criteria to establish a diagnosis of NTOS and there is great variability in follow-up time and criteria for outcome. Various methods including subjective reporting, functional questionnaires, quality of life questionnaires, visual analogue scales and satisfaction scores have all been used to try to determine whether treatment has benefitted the patient. The etiology of the problem, patient demographics, the description and duration of symptoms, the response to the selective use of anterior scalene muscle blocks and surgical technique are amongst the major factors that have been studied in an attempt to predict outcome. Postoperative complications in most contemporary series cite relatively low complication rates, most of which are minor. Neurological injuries during surgical decompression demonstrate a much lower incidence in recent publications, at no more than 1 % or less. In conclusion, few areas in surgery are as controversial as the topic of surgical therapy for NTOS. However, most who treat such patients believe that surgery remains an excellent option in properly selected patients with NTOS, particularly in those who have failed conservative treatment.