Surgical Implications of Upper Thoracic Independent Sympathetic Pathways

Ehrlich, Emerich; Alexander, William F.

doi:10.1001/archsurg.1951.01250030619001

Cited by 17 publications

(6 citation statements)

References 4 publications

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“…Operative resection of this ganglion should result in effective sympathectomy and the arrest of palmar sweating. The recurrence of palmar sweating despite T 2 -T 3 resection in rare cases may be attributable to the existence of anatomical variations, including accessory or intermediate sympathetic ganglia located outside the sympathetic trunk, 98 or the presence of the inconsistent nerve of Kuntz, which bypasses the second thoracic ganglion. 99 In such cases, resympathectomy should be performed, preferably by the dorsal approach as suggested by Lemmens.…”

Section: Discussionmentioning

confidence: 99%

The treatment of primary palmar hyperhidrosis: A review

2000

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Primary palmar hyperhidrosis (HH) is a pathological condition of overperspiration caused by excessive secretion of the eccrine sweat glands, the etiology of which is unknown. This disorder affects a small but significant proportion of the young population all over the world. Neither systemic nor topical drugs have been found to satisfactorily alleviate the symptoms. Although the topical injection of botulinum has recently been reported to reduce the amount of local perspiration, long-term results are required before a definitive evaluation of this method can be made. Hypnosis, psychotherapy, and biofeedback have been beneficial in a limited-number of cases. While radiation achieves atrophy of the sweat glands, its detrimental effects prohibit its use. Iontophoresis has attained some satisfactory results but it has not been assessed long term. Percutaneous computed tomography-guided phenol sympathicolysis achieves excellent immediate results, but its long-term failure rate is prohibitive. Furthermore, percutaneous radiofrequency sympathicolysis may be an effective procedure, but its long-term results are not superior to surgical sympathectomy. On the other hand, surgical upper dorsal (T2-T3) sympathectomy achieves excellent long-term results and the thoracoscopic approach has supplanted the open procedures. Despite some sequelae, mainly in the form of neuralgia and compensatory sweating which cannot be predicted and may be distressing, surgical sympathectomy remains the best treatment for palmar hyperhidrosis.

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Section: Discussionmentioning

confidence: 99%

The treatment of primary palmar hyperhidrosis: A review

2000

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“…This operation is used in the treatment of the nagging pain in chronic pancreatitis and pancreatic cancer (Naidoo et al) . The success of the sympathetic denervation procedure depends upon the presence or absence of visible or barely perceptible accessory ganglia and pathways other than those classically described (Naidoo et al;Hoffmann;Kuntz & Alexander, 1950;Ehrlich & Alexander, 1951). The region of second thoracic ganglion is considered as a key ganglion for any sympathectomy (Ramsaroop et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Variations of Thoracic Splanchnic Nerves and its Clinical Implications

et al. 2005

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SUMMARY:The present study reports an anomalous branching pattern of the thoracic sympathetic chain. At the level of T3 ganglion, an anomalous branch i.e accessory sympathetic chain (ASC) descended anteromedial to the main sympathetic chain (MSC). The MSC and the ASC communicated with each other at the level of T9, T10 and T11 ganglion, indicating the absence of classical pattern of greater, lesser and least splanchnic nerves on the right side. However, on the left side, the sympathetic chain displayed normal branching pattern. We opine that the ASC may be representing a higher origin of greater splanchnic nerve at the level of T3 ganglion and the branches from MSC at T9, T10 and T11 ganglion may be the lesser and least splanchnic nerves, which further joined the ASC (i.e presumably the greater splanchnic nerve) to form a common trunk. This common trunk pierced the right crus of diaphragm to reach the right suprarenal plexus after giving few branches to the celiac plexus.Awareness and knowledge of such anatomical variants of thoracic sympathetic chain may be helpful to surgeons in avoiding any incomplete denervation or preventing any inadvertent injury during thoracic sympathectomy.

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“…The causes of recurrent hyperhidrosis after sympathectomy by VATS are reported to be multifactorial and include an incomplete sympathetic nerve at the origin of the sympathetic nerve, encountered in 20% of patients in whom the sympathetic nerve originates from the first thoracic sympathetic ganglion (inferior to the stellate ganglion), bypassing the sympathetic ganglion by the Kuntz fiber and connecting to the brachial plexus, as well as local regeneration of the resected nerve. [10][11][12][13] To prevent recurrence, detection and accurate localization of the second sympathetic ganglion, confirmation of anatomic variations of the accessory nerve, the accessory ganglion, and the Kuntz fibers, as well as resection of a broad margin of 3 to 5 cm around the second sympathetic ganglion is necessary. 14,15 The adequacy of the sympathectomy can be monitored by measuring bilateral palmar surface temperatures or by measuring plethysmographic blood flow.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reoperation for Essential Hyperhidrosis

Yoon

Lee

Kim

et al. 1999

Asian Cardiovasc Thorac Ann

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Palmar hyperhidrosis has a recurrence rate of 0% to 5% after thoracic sympathectomy. From January 1992 to October 1997, thoracic sympathectomy was performed by video-assisted thoracoscopic surgery for hyperhidrosis in 490 patients of whom 5 (2 male and 3 female with a mean age of 20 years) experienced recurrent hyperhidrosis in the early (< 7 days) or late (up to 6 months) postoperative period. All patients had moderate to severe pleural adhesions in the previous sympathectomy sites but no operative complications or crossover to thoracotomy occurred. Surgery resulted in satisfactory outcomes showing that video-assisted thoracoscopic sympathectomy was effective in treating recurrent hyperhidrosis. Prevention of recurrence requires the identification and resection of the second thoracic sympathetic ganglion as well as the Kuntz fibers.

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Surgical Implications of Upper Thoracic Independent Sympathetic Pathways

Cited by 17 publications

References 4 publications

The treatment of primary palmar hyperhidrosis: A review

The treatment of primary palmar hyperhidrosis: A review

Variations of Thoracic Splanchnic Nerves and its Clinical Implications

Reoperation for Essential Hyperhidrosis

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