New Stereotactic Technique for Percutaneous Thermocoagulation Upper Thoracic Ganglionectomy in Cases of Palmar Hyperhidrosis

Chuang, King-Shun; Liou, Nien-Hsien; Liu, Jiang-Chuan

doi:10.1227/00006123-198803000-00031

Cited by 41 publications

(8 citation statements)

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“…[32] In the past decade, other percutaneous techniques with phenol injections and radiofrequency lesioning of the sympathetic ganglia initially received interest but have not gained widespread acceptance due to local toxicity and high recurrence rates. [2,6,32,33]…”

Section: Percutaneous Proceduresmentioning

confidence: 99%

Thoracoscopic sympathectomy: techniques and outcomes

Ss²,

Wc³

et al. 1998

FOC

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Thoracic sympathectomy is an important option in the treatment of palmar hyperhidrosis and pain disorders. Earlier surgical procedures were highly invasive with known morbidity, acceptable outcome, and established recurrence rates that were the limitations to considering surgical treatment. Thoracoscopic sympathectomy is a minimally invasive procedure that allows detailed visualization of the sympathetic ganglia and minimal postoperative morbidity; however, outcome studies of this technique have been limited. The authors treated 39 patients with 60 thoracoscopic procedures, and the outcomes in this small series were equivalent to previously established open surgical techniques; however, operative moribidity rates, hospital stay, and time of return to normal activity were substantially reduced. Complications and recurrence of symptoms were also comparable to previous reports. Overall patient satisfaction and willingness to repeat the operative procedure ranged from 66 to 96% in all patients. Patients and physicians can consider minimally invasive thoracoscopic sympathectomy procedures as an option to treat sympathetically mediated disorders because of the procedure's reduced morbidity and at least equivalent outcome rates in comparison to other treatments.

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Section: Percutaneous Proceduresmentioning

confidence: 99%

Thoracoscopic sympathectomy: techniques and outcomes

Ss²,

Wc³

et al. 1998

FOC

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“…Some advocate it as a simple method that can be performed while the patient is receiving local anesthesia. 3,14 Based on our study, we do not believe that this procedure could locate the target ganglion accurately using only x-ray films, because at least 16% of the T-2 ganglia are embedded completely in front of the rib trunk. These Type III ganglia are absolutely impossible to reach via a dorsal approach.…”

Section: J Neurosurg / Volume 85 / August 1996mentioning

confidence: 83%

“…It is of unknown etiology and may cause professional, social, and emotional embarrassment. 2,3,4,9 Experimental studies indicate that the T-2 ganglion plays a significant role in hyperhidrosis. Surgical intervention is currently accepted as appropriate management for curing or improving the intractable symptoms in the majority of patients.…”

mentioning

confidence: 99%

Orientation landmarks of endoscopic transaxillary T-2 sympathectomy for palmar hyperhidrosis

Chiou¹,

Liao²

1996

Journal of Neurosurgery

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The identification of the T-2 ganglion through a narrow operative viewfield is the greatest challenge in performing endoscopic transaxillary T-2 sympathectomy, especially for a surgeon who is unfamiliar with the technique. The authors describe a simple anatomical method for identifying the T-2 ganglion during the operation, based on a study of 17 adult cadavers. First, a similar clinical procedure was performed along the anterior or middle axillary line via the second to fourth intercostal spaces to measure the aiming angles and intrathoracic depth needed. Second, the regional anatomical structures and their relationship to bilateral T-2 ganglia were delineated. It was discovered that the superior intercostal artery, a branch of the subclavian artery, was an accessible landmark. This small vessel existed in 87.5% of the cadavers studied. It consistently runs lateral to the parallel sympathetic chain at an average distance of 10 mm. Most important is that it can be easily distinguished where it runs across the inner part of the second rib. The authors emphasize that the superior intercostal artery should be a very beneficial landmark for surgical orientation.

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“…Consiste en un incremento de la sudoración ecrina por encima de lo requerido para el control de la termorregulación en una o más áreas corporales, sobre todo a nivel palmar, siendo también frecuente a nivel axilar, plantar y facial. Habitualmente su causa es desconocida (idiopática) y se estima una incidencia inferior al 1%, siendo mayor en Estados Unidos (2.8%) y poblaciones asiáticas (4-5%) 2,11,55,59,82 . En un 70% o más de los casos se inicia en la niñez y en un 16-20% en la adolescencia, siendo poco frecuente su comienzo en adultos 28,46,62,72 .…”

Section: Hiperhidrosis Focal Patológicaunclassified