title: [Image-guided pain therapy. Sympathicolysis].
abstract: BACKGROUND
  In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome.
  
  
  METHODS
  The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added.
  
  
  RESULTS
  The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome.
  
  
  CONCLUSIONS
  After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar SL.
authors.affiliation: Institut für Radiologie und Interventionelle Therapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland, mburbelko@t-online.de.
authors.forename: M
authors.initials: M
authors.lastname: Burbelko
authors.forename: H-J
authors.initials: HJ
authors.lastname: Wagner
authors.forename: M
authors.initials: M
authors.lastname: Gutberlet
authors.forename: M
authors.initials: M
authors.lastname: Grothoff
mesh_terms: D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000431:Ethanol / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012597:Sclerosing Solutions / Q000008:administration & dosage; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000187:drug effects*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D012597:Sclerosing Solutions; D000431:Ethanol