Can Thoracic Sympathetic Nerve Damage Be Reversed?

Abstract

Background Function of the thoracic sympathetic chain (TSC) reportedly recovers after surgical clips are removed. Hence, this study was designed to study nerve regeneration after unclipping the TSC.

Methods The bilateral TSCs of six goats were studied; the goats were separated into three groups (groups I, II, and III) during excision, clipping, and unclipping. During surgery, the TSCs were excised with a scalpel in group I and clipped in groups II and III. In group III, the clips were removed 1 month postoperatively and observed for possible nerve healing for 1 month. All TSCs were examined histologically following en block resection at 1 month postoperatively in groups I and II and at 2 months postoperatively in group III.

Results Inflammation in nerve sections was noted following clip removal. Furthermore, there was significant degeneration and cell infiltration in the nerve fibers of the clipped regions. The Schwann cells around the peripheral nerve endings in the unclipped regions facilitated nerve transmission by reconstitution of myelin.

Conclusion Clipping the TSC can cause histologic degeneration; however, histologic nerve regeneration occurs after unclipping.

Keywords

experimental - surgery/incisions - histology

• References

• 1 Johnson JP, Obası C, Hahn MS, Glatleider P. Endoscopic thoracic sympathectomy. J Neurosurg 1999; 91 (1) 90-97
• 2 Unal O, Citgez B, Battal M, Karatepe O. Single incision thoracoscopic sympathectomy for hyperhidrosis. BMJ Case Rep 2012; 2012: 2012
• 3 Hashmonai M, Assalia A, Kopelman D. Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect?. Surg Endosc 2001; 15 (5) 435-441
• 4 Hashmonai M, Kopelman D. History of sympathetic surgery. Clin Auton Res 2003; 13 (Suppl. 01) I6-I9
• 5 Suzuki J, Takaku A, Kodama N, Sato S. An attempt to treat cerebrovascular 'Moyamoya' disease in children. Childs Brain 1975; 1 (4) 193-206
• 6 Sung SW, Kim JS. Thoracoscopic procedures for intrathoracic and pulmonary diseases. Respirology 1999; 4 (1) 19-29
• 7 Khan IA. Long QT syndrome: diagnosis and management. Am Heart J 2002; 143 (1) 7-14
• 8 Ibrahim M, Menna C, Andreetti C , et al. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis. Interact Cardiovasc Thorac Surg 2013; 16 (6) 834-838
• 9 Cameron AE, Ojimba TA. Evaluation of the impact of transthoracic endoscopic sympathectomy on patients with palmar hyperhidrosis. Eur J Vasc Endovasc Surg 2004; 27 (5) 567
• 10 Kwong KF, Hobbs JL, Cooper LB, Burrows W, Gamliel Z, Krasna MJ. Stratified analysis of clinical outcomes in thoracoscopic sympathicotomy for hyperhidrosis. Ann Thorac Surg 2008; 85 (2) 390-393 , discussion 393–394
• 11 Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137 (6) 1370-1376 , discussion 1376–1377