Abstract
Purpose The objective of the present study was to evaluate the benefit of a thoracic, computed
tomography-guided sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis
of the hands. In addition, the influence of the amount and distribution of the administered
sympathicolytic agent was to be assessed.
Patients and Methods Retrospectively, 78 patients [13 (16.7 %) men, mean age 31.2 ± 9 years and 65 (83.3 %)
women, mean age 34.2 ± 12 years], who had been treated using CTSy, were included in
the study. The indication for treatment was primary focal palmar hyperhidrosis grade
II and grade III after exhaustion of all conservative treatment options and a continued
high level of suffering. CTSy was performed after establishing the entry plane at
the level of the intervertebral space T2 / T3 via a dorsolateral approach using a
22-G coaxial needle. On average 5 (2–10) ml of a sympathicolytic mixture (10 ml consisting
of 8 ml 96 % alcohol, 1.6 ml 0.5 % Carbostesin and 0.4 ml 0.9 % NaCl solution, with
added amounts of contrast medium) were instilled. The volume of distribution of the
sympathicolytic agent was determined in craniocaudal direction using CT images. The
patients evaluated their sense of discomfort preinterventionally, 2 days postinterventionally,
and 6 and 12 months after the intervention, on the basis of a Dermatology life Quality
Index (DLQI) as well as the side effects that occurred.
Results The technical success rate of CTSy was 100 %. No major complications occurred. The
interventions performed led to a significant reduction (p < 0.001) in the preinterventional
sense of discomfort 2 days, 6 and 12 months after CTSy. As the most common side effect,
compensatory sweating was reported by 16/78 (20.5 %) of the patients over the further
course. In all of these patients, the volume of sympathicolytic agent administered
was below 5 ml. In no case did the sympathicolytic agent extend caudally beyond the
base plate of Th 3. No compensatory sweating of the back was observed in 5/78 (6.4 %)
patients; here the sympathicolytic volume was above 5 ml and extended significantly
caudally below the baseplate of T3.
Transient miosis and ptosis was found in 8/78 (10.3 %) patients. In all of these patients,
the volume of sympathicolytic agent administered was above 5 ml and it extended markedly
cranially beyond the upper plate of T2. A mild to moderate recurrent sweating developed
in 35/78 (44.9 %) patients, which was more marked if the volume of sympathicolytic
administered was below 5 ml and slightly more pronounced on the left than on the right.
Given a high level of satisfaction overall, 71/78 (91.0 %) patients said that they
would undergo the intervention again.
Conclusion For patients with primary, focal palmar hyperhidrosis CTSy represents a therapeutic
option that offers good benefit and has few side effects. The amount and spatial distribution
of the sympathicolytic agent has an influence on the therapeutic outcome and the side
effects.
Key Points:
CT-assisted thoracic sympathicolysis is a minimally invasive, low-complication therapy
for treatment of severe forms of primary hyperhidrosis palmaris.
CT-assisted thoracic sympathicolysis can usually be performed on an outpatient basis.
The quantity and local distribution of the sympathicolytic agent has an influence
on the therapeutic outcome and the side effects.
Citation Format
Andresen J, Scheer F, Schlöricke E et al. CT-assisted thoracic sympathicolysis for
therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence
of the amount and position of the sympathetic agent on the therapeutic outcome and
side effects. Fortschr Röntgenstr 2021; 193: 574 – 581
Key words CT-guided thoracic sympathicolysis - minimally invasive therapy - primary palmar hyperhidrosis
- sympathicolytic agent
