title: Percutaneous CT-guided chemical thoracic sympathectomy for patients with palmar hyperhidrosis after transthoracic endoscopic sympathectomy.
abstract: BACKGROUND
  Palmar hyperhidrosis is a common functional disorder in the Asians. Currently, transthoracic endoscopic sympathectomy (TES) is considered to be the treatment of choice for this entity because of its high initial success rate and minimal morbidity. However, primary failure and recurrence of hyperhidrosis occurred in some patients, even with a very low incidence. We present our experience in the treatment of primary failure and recurrence of hyperhidrosis after TES by means of percutaneous computer tomography (CT) guided ethanol thoracic sympathectomy.
  
  
  METHODS
  From July 1999 to July 2001, 11 patients (2 males and 9 females with a mean age of 25.9 years, range: 19-44 years) of this subgroup underwent percutaneous CT-guided chemical thoracic sympathectomy. Failure of the first sympathectomy was caused by severe pleural adhesion (from the previous operative findings) in 7 patients. The remaining 4 patients were recurrent palmar hyperhidrosis. All patients underwent unilateral procedures (3 on the right and 8 on the left).
  
  
  RESULTS
  All patients were followed for at least 2 years after the treatment. Needle puncture was possible without difficulty in all patients. All patients had satisfactory results with minimal complication. No recurrence was noted at follow-up.
  
  
  CONCLUSIONS
  In summary, percutaneous CT-guided ethanol thoracic sympathectomy could be an easy, safe, and alternative strategy to treat patients with palmar hyperhidrosis after failure or recurrence after TES.
authors.affiliation: Department of Neurosurgery, Jen-Ai Hospital, Taichung, Taiwan.
authors.forename: Kung-Shing
authors.initials: KS
authors.lastname: Lee
authors.forename: Chih-Lin
authors.initials: CL
authors.lastname: Chuang
authors.forename: Chih-Lung
authors.initials: CL
authors.lastname: Lin
authors.forename: Ling-Chin
authors.initials: LC
authors.lastname: Tsai
authors.forename: Shiuh-Lin
authors.initials: SL
authors.lastname: Hwang
authors.forename: Shen-Long
authors.initials: SL
authors.lastname: Howng
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D005728:Ganglia, Sympathetic / Q000000981:diagnostic imaging; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery / Q000628:therapy*; D008297:Male; D012008:Recurrence; D019233:Retreatment; D025321:Surgery, Computer-Assisted; D013562:Sympathectomy; D013563:Sympathectomy, Chemical; D013904:Thoracic Vertebrae / Q000294:innervation / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome