CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis

Abstract

Background The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. Materials and Methods In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. Results Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. Conclusion For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

“…Resen et al conducted a study on the effectiveness of CT-guided chemical destruction of the thoracic sympathetic nerve chain with absolute alcohol in treating palmar hyperhidrosis. The study included 86 cases and the results showed that the short-term curative effect was observed to be 100% ( 27 ), and the curative effect is comparable to ETS within one year but with fewer complications ( 28 ). However, although absolute alcohol chemical damage block has high immediate efficiency, the time effect is far less lasting than ETS, with a 3 year recurrence rate as high as 68.75% and a 55.88% incidence of postoperative compensatory hyperhidrosis.…”

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

“…Kuijpers et al, [1] using a bilateral one-stage single-port sympathectomy procedure, reported not only a significant reduction in HDSS scores but also severe compensatory hyperhidrosis with a frequency ranging between 17.1% and 32.8% of patients. In a comparative study, Andresen et al [31] compared CTguided thoracic sympathicolysis and video-assisted thoracoscopic sympathectomy for PPH and found both treatments resulted in a marked reduction of symptoms, but transient compensatory sweating was reported in 14.9% of cases after both approaches, and videoassisted thoracoscopic sympathectomy resulted in postoperative pneumothorax in 8% and temporary thoracotomy pain in 14% of patients. In another comparative study of T3 thoracoscopic sympathectomy versus T3+T4 sympathectomy, Yang et al [32] found that both techniques resulted in a significant reduction of a sweating index, but they also resulted in compensatory hyperhidrosis with an incidence of 5-10%, with the possibility of postoperative neuralgia and pneumothorax requiring chest tube placement.…”