Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweatng by clipping T4

Neumayer, Christoph; Zacherl, Johannes; Holak, Gregor; Függer, R.; Jakesz, R.; Herbst, F.; Bischof, G.

doi:10.1007/s00464-002-8940-5

Cited by 73 publications

(9 citation statements)

References 17 publications

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“…Comparably good results were only achieved by Van't Riet et al [28] after limited T3 dissection in a small number of patients. Our results confirm the initial data on patients with HH after ESB4 treatment [14,23] and support the hypothesis of Lin and Telaranta [13] that preservation of the negative afferent tone to the hypothalamus can result in less CS. In our series CS was highest in patients with FH, which has also been noticed by Duarte and Kux [4].…”

Section: Discussionsupporting

confidence: 94%

“…In our series, all patients reporting an aggravation of sweating in other regions (e. g., lumbar, abdominal region, thighs) without special labor or psychologic stress were judged as compensatory sweators. A total of 8.5 % of our patients after ESB4 treatment developed CS, which represents a clear improvement compared to 55.6 % after T2 to T4 ETS in our previous reports [22,23,31]. Comparably good results were only achieved by Van't Riet et al [28] after limited T3 dissection in a small number of patients.…”

Section: Discussionsupporting

confidence: 43%

“…Obviously, patients felt more comfortable when a certain minimal moistness was maintained and exsiccation was avoidable. Patients suffering from fissured palms especially during winter have not been found in this series, whereas some patients complained about this problem in our previous series after T2-T4 endoscopic thoracic sympathicotomy (ETS) [23].…”

Section: Discussionmentioning

confidence: 83%

“…Table 1. The procedure of ESB has been previously reported [23]. In short, under general anesthesia, single-lumen intubation and lateral decubitus positioning of the patient a pneumothorax was achieved with a Verres needle.…”

Section: Introductionmentioning

confidence: 99%

“…ESB3 has been proposed for FH with or without upper limb HH. ESB4 is used in cases of upper limb HH with the potential to successfully reduce CS [14,23]. These findings were based on the speculation that CS might be a phenomenon caused by the interruption of afferent sympathetic fibers to the anterior portion of the hypothalamus when the sympathetic trunc is severed at the level of T2 and/or T3 [13].…”

Section: Introductionmentioning

confidence: 99%

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Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing

Neumayer

Zacherl

Holak

et al. 2003

Clinical Autonomic Research

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Endoscopic thoracic sympathetic block (ESB) has recently become a popular modification of sympathetic surgery, as it offers the potential chance of reversibility. In order to reduce side effects such as compensatory sweating limited ESB at the levels of the T2, T3 or T4 ganglia has been recommended (Lin/Telaranta classification). We present our experience and initial results with this technique. From 6/2001 to 2/2003, 184 ESB procedures were performed in 94 patients. ESB4 was carried out in 53 patients for hyperhidrosis (HH) of the upper limb. In 23 patients ESB3 was performed for craniofacial HH and 18 patients suffering from facial blushing were treated by ESB2. Median follow-up was 5.2-7.5 months.Success rates were similar (~100%) in all groups. Compensatory sweating was found in 25% in the ESB3 compared to 12.5 % in the ESB2 and 8.5 % in the ESB4 group (p < 0.05). Gustatory sweating did not differ significantly between the groups (6.3 % in ESB2, 5% in ESB3 and 2.1 % in ESB4 group). Five patients were reoperated in the ESB3 group (3 because of a side-difference of the effect in the face, 1 patient due to incomplete Horner's syndrome and 1 due to massive compensatory sweating). In the ESB4 group all patients were satisfied with the outcome, whereas in the ESB2 group 6.3% and in the ESB3 group 13.9% were partly satisfied. Limited sympathetic surgery offers comparably high success and satisfaction rates along with a low rate of side effects.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing

Neumayer

Zacherl

Holak

et al. 2003

Clinical Autonomic Research

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Effect of Endoscopic Thoracic Sympathetic Block on Plantar Hyperhidrosis

Neumayer

Panhofer²,

Zacherl³

et al. 2005

Arch Surg

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Hypothesis: Endoscopic thoracic sympathetic block at T4 (ESB4) provides excellent results in patients with primary hyperhidrosis (HH) of the upper limb. Most patients have combined palmo-plantar or palmo-axillaryplantar HH. This study evaluates the clinical outcome of patients with upper limb HH with special emphasis on plantar sweating and patients' quality of life. Design: Review of a prospectively gathered database. Setting: Tertiary care university teaching hospital. Patients: The cohort included 73 patients (50 women and 23 men; mean age, 30.2 years). Twenty-six patients had palmar; 3, isolated axillary; and 44, combined HH. Sixty-six patients (90.4%) had concomitant plantar HH. Interventions: One hundred forty-five operations were performed by applying one 5-mm clip above and below the fourth sympathetic ganglion. Results: Of palms, 71.9% were completely and 28.1% were nearly dry. Corresponding percentages were 45.1% and 50.5% for armpits and 4.5% and 37.9% for the soles, respectively. Of soles, 42.4% remained unchanged and 15.2% became slightly worse. Compensatory sweating occurred in 19.4% of patients, with 2.8% having severe compensatory sweating. Feet were rarely affected by compensatory sweating (5.6%). Gustatory sweating was reported by 31.9% of patients but did not bother them. Quality of life improved significantly after ESB4. Most patients (87.5%) were completely satisfied with the outcome; 9.7% were partly satisfied. Conclusions: In the treatment of upper limb HH, ESB4 yields excellent success rates. Plantar sweating can be relieved in nearly half of patients, although exact neurophysiologic mechanisms remain unclear. Incidence of compensatory and gustatory sweating is low, contributing to a high patient satisfaction and improvement in quality of life.

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