Experimental selective sympathicotomy (ramicotomy) and sympathetic regeneration

Oliveira, Humberto; Ximenes, Manoel; Filho, Flávio Brito; Carvalho, Paulo H.C.; GamaFilho, José Belarmino; Parra, Edwin Roger; Capelozzi, Vera Luíza; DeCampos, José Ribas Milanez

doi:10.1510/icvts.2009.202150

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…The present study identified no significant differences with respect to the inflammatory process of clipping compared to section. It is speculated the possibility of not triggering the process of Wallerian degeneration 19 , what this paper does not show. Here was no significant the difference between the groups regarding the inflammatory process and its degree.…”

Section: Assessment Of Inflammation and Necrosiscontrasting

confidence: 64%

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Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

MARINHO¹,

Filho²,

Malafaia

et al. 2012

Acta Cir. Bras.

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PURPOSE: To study the macro and microscopic evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits, quantifying the collagen in the lesions. METHODS: Twenty rabbits were divided into two groups of ten, doing in group 1 (section) section of the right cervical sympathetic nerve, while in group 2 (clipping) clipping of the nerve. All rabbits were induced to death on the seventh day after surgery. The macroscopic variables were: consequences of nerve lesion, clip appearance, presence of infection and adhesions around the nerve. Microscopy used hematoxylin-eosin staining to evaluate the stages and the degree of inflammation and necrosis, and F3BA Picrosirius red staining to quantify collagen. Mann-Whitney test was used for comparisons of collagen types I and III between groups. Fisher exact test analyzed the macroscopic variables, the degree of inflammation and necrosis. RESULTS: There was no discontinuity of nerve injury in the clipping group, as well as the clip was closed in all animals. The presence of severe adhesions was significantly higher in the clipping group (p<0.05). There was no significant difference on other variables macroscopically analyzed. There was no significant difference between groups regarding the type of inflammatory process and its intensity, as well as the presence of necrosis and collagen deposition in the nerves. CONCLUSIONS: In the macroscopic evaluation, the section caused discontinuity, which did not occur in the clamping group; there was no development of local infection; the clipping of the cervical sympathetic nerve was linked to the presence of a greater number of adhesions in comparison to the section group. Microscopically, no difference existed in relation to the type and intensity of inflammation reaction between the groups; occurred predominance of chronic and severe inflammation on the specimens; the necrosis was noticed equally in both groups; there was predominance of type I collagen deposition in relation to type III in both groups.

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Section: Assessment Of Inflammation and Necrosiscontrasting

confidence: 64%

“…Regarding to collagen, Oliveira et al 19 noted elevated levels of it in both types, I and III, increasing up to its peak point, on 135 th day, postoperatively.…”

Section: Assessment Of Inflammation and Necrosismentioning

confidence: 98%

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

MARINHO¹,

Filho²,

Malafaia

et al. 2012

Acta Cir. Bras.

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“…Interestingly, T3 ramicotomy resulted in a lower rate of compensatory sweating compared to T3 sympathetic clipping, and there was no significant difference in the rate of satisfaction for palmar hyperhidrosis treatment (14). Furthermore, due to the high rate of ramicotomy recurrence but less adverse effects than conventional sympathectomy, sympathetic regeneration is the key factor associated with the recurrence of symptoms after ramicotomy in humans (15). In Kim et al study, video-assisted thoracoscopic (VAT) T2 sympathetic clipping and VAT ramicotomy were performed in patients with craniofacial hyperhidrosis to reduce the incidence of compensatory sweating and were shown to be significantly lower than T2 sympathetic clipping despite the high operating failure rates (16).…”

Section: Discussionmentioning

confidence: 98%

The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

et al. 2021

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Background: Primary hyperhidrosis is a sympathetic disorder characterized by prolonged and uncontrollable sweating. It is associated with emotional stress or psychological causes that preferably affects the axillae, palms, feet, and face. Video-assisted thoracoscopic sympathetic surgery is currently a globally recognized treatment for primary palmar hyperhidrosis (PH). However, compensatory sweating (CS) is the most prominent long-term adverse effect of thoracoscopic sympathectomy. Objectives: Here, we aim to perform selective sympathetic ramicotomy for primary palmar hyperhidrosis patients and evaluate the clinical outcomes of satisfaction, as well as the effect on the frequency, location, and severity of compensatory sweating. Methods: In this single-arm trial study, 24 sympathectomies were carried out on 12 patients with primary palmar hyperhidrosis who were candidates for bilateral thoracoscopic selective sympathectomy (ramicotomy) at Imam Khomeini Hospital. The patients’ demographic information was interviewed and followed up using telephone questionnaires in the health center one week after surgery. Then, the rates of compensatory sweating, satisfaction, and failure or recurrence were retrospectively analyzed. Results: No significant differences were observed between age, gender, weight, BMI, and compensatory sweating rates. Notwithstanding, there was a statistically significant difference in the severity of compensatory sweating with patients’ height (P = 0.016). Compensatory sweating occurred in 66.7% of the patients; 50% of the patients were mild, 16.7% of the patients were moderate, and there was no intolerable compensatory sweating or recurrence. The most incidence of compensatory sweating was on the lower back. The rate of satisfaction was 94.5 ± 7.8%. Conclusions: Selective thoracoscopic sympathectomy (ramicotomy) is an effective surgical procedure with a very high level of precision and satisfaction. This technique hence should be considered the method of choice for the treatment of primary palmar hyperhidrosis.

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“…Thoracoscopic ramicotomy, which involves cutting only the rami communicantes (RCs), has a theoretical advantage over other methods and involves a less‐aggressive surgical approach for treating hyperhidrosis (Kim et al, ; Lee et al, ). However, the high recurrence rate could necessitate abandonment of this approach (Oliveira et al, ).…”

Section: Introductionmentioning

confidence: 99%

Topographical study of the connections of the rami communicantes from the first to the fifth thoracic sympathetic ganglia

Won

Lee

et al. 2018

Clinical Anatomy

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This study investigated the morphological variations and histological patterns of the rami communicantes (RCs) arising from the first to the fifth thoracic sympathetic ganglia, and considered the clinical significance of these variations. Fifty upper thoracic portions from 26 adult Korean cadavers were used in this study. There were 731 RCs arising from the first to the fifth thoracic sympathetic ganglia. They were classified into three types depending on the connection between the sympathetic ganglion and the intercostal nerves: in type I, the RCs connected the ganglion to the corresponding intercostal nerve, and in types II and III, respectively, they connected it to the nerve one level above or below the corresponding intercostal nerve. Some RCs of types I and II could not be observed without additional preliminary surgical procedures. Diverse combinations of RC types arose from the first to the fifth thoracic sympathetic ganglia, combinations of types I and III being the most common (70%) in the first sympathetic ganglion and those comprising only type I being most frequent in the other ganglia. The RCs could not be identified by the naked eye in either fresh or fixed cadavers, so they were confirmed on the basis of their histological appearance. These results are expected to improve knowledge of morphological variations of the RCs in the upper five thoracic sympathetic ganglia, and to provide helpful information for clinical management in this region. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

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Experimental selective sympathicotomy (ramicotomy) and sympathetic regeneration

Cited by 9 publications

References 8 publications

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

Topographical study of the connections of the rami communicantes from the first to the fifth thoracic sympathetic ganglia

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