I am brand new to this forum. I just saw Dr Justin Brown at UCSD. He is a neurosurgeon on the TOS team. He is very likable and knowledgeable. He has recommended surgery for me unfortunately, as I failed PT. I have both neuro and vascular symptoms bilaterally. He is going to do a scalenectomy which does not involve any rib removal. Hopefully my recovery and complication rate will be lower than what I have been reading about in these threads.