title: Upper thoracic sympathetic chain neurolysis under CT guidance. A two year follow-up in patients with palmar and axillary hyperhidrosis.
abstract: OBJECTIVE
  To evaluate the efficacy, safety and middle-term results of upper thoracic sympathetic chain neurolysis performed under CT guidance in patients with palmar/axillary hyperhidrosis.
  
  
  METHODS
  From April 1999 to July 2000 we performed 30 upper thoracic sympathetic chain neurolysis in 15 patients presenting with palmar/axillary hyperhidrosis (6 M, 9 F, mean age 29.5 years). Neurolysis was performed under CT guidance injecting 2-10 ml of a solution of phenol 8%, glycerine 20% and saline through 22 G needles placed in the paraspinal space at T3 level through a paraspinal extrapleural approach. At least one week was allowed between neurolysis of right and left thoracic sympathetic chain in the same patient. Procedures were performed on outpatient basis. Patients were followed up with interviews and/or physical examination every 6 months for 2 years.
  
  
  RESULTS
  All patients experienced immediate cessation of symptoms. Three patients (20%) experienced one-sided recurrence of symptoms 5, 7 and 12 months respectively after the first neurolysis, which disappeared after a repeated procedure. Two (13%) patients showed a slight Horner's syndrome immediately after the procedure, which resolved in 1 and 2 months respectively. Two patients (13%) experienced pain in the arm on the same side of the neurolysis, which resolved in 1 week. Three (20%) patients experienced mild compensatory sweating. All patients declared they were satisfied with the outcome of the neurolysis when interviewed at 2 years follow up from the first procedure, with no recurrence of symptoms.
  
  
  CONCLUSIONS
  Upper thoracic sympathetic chain neurolysis performed under CT guidance in patients with palmar/axillary hyperhidrosis is a safe procedure, with low rate of complications and good results at 2 years follow-up.
authors.affiliation: Dipartimento Assistenziale di Radiologia e Radioterapia, Università Federico II, Napoli, Italy. maurizio.romano@mail.cmn.area.na.cnr.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Romano
authors.forename: Angela
authors.initials: A
authors.lastname: Giojelli
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Mainenti
authors.forename: Oscar
authors.initials: O
authors.lastname: Tamburrini
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
mesh_terms: D000328:Adult; D001365:Axilla; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000628:therapy*; D008297:Male; D017060:Patient Satisfaction; D019800:Phenol / Q000008:administration & dosage; D013563:Sympathectomy, Chemical / Q000379:methods*; D013909:Thorax / Q000294:innervation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019800:Phenol