Given that you have an anatomical reason for developing TOS, you may fare better with surgery but it's no guarantee.

Personally, when I went through this the first time around, I was pre-disposed to TOS due to the bony abnormality involving the 1st rib. It took an event to "excite" the TOS and it never calmed down. Once started, it continued downhill. The only relief I had in 21 months from the trigger event to surgery was the month after the botox shot. I had complete relief for 4 weeks and it was great! When it wore off, the TOS symptoms returned with a vengence. I opted for surgery and I'm glad I did. This doesn't mean you will have the same results.

I have TOS on the other side now and I have a cervical rib on that side. Lucky me to have two different anatomical reasons for being prone to TOS. Despite the good outcome I had on the right side, I'm hesitant to go the surgery route again. I don't feel like taking another gamble.