CT-GUIDED THORACIC SYMPATHICOLYSIS IN PATIENTS WITH SEVERE PRIMARY PALMAR HYPERHIDROSIS

Background: The aim of the present study was to compare the methods CTSy and ETS with regard to their clinical success and to determine minor and major complications. Methods: Retrospectively, 68 patients (mean age 37.2 +/- 15 years) who had been treated using CTSy and 64 patients (mean age 34.6 +/11 years) who had been treated using ETS were included. The indication for treatment was primary focal palmar hyperhidrosis after exhaustion of all conservative treatment options and a continued high level of suffering. All patients evaluated their sense of discomfort within the context of a quality control before the start of treatment, two days postinterventionally/postoperatively, and six and twelve months after treatment, on the basis of a Dermatology Quality of Life Index (DLQI) as well as the side effects that occurred. As statistical test procedures, the Wilcoxon rank-sum test was applied to test the differences in DLQI values over the course and the Mann-Whitney U test to compare the different methods. Results: Both methods were technically feasible in all patients. Both treatments led to a marked reduction in the preinterventional sense of discomfort two days postinterventionally/postoperatively as well as six and twelve months after treatment (p < 0.001), whereby mild recurrent sweating occurred over the further course, which was significantly higher in the patients who had undergone CTSy. Temporary miosis and ptosis was found in 8 of 68 (11.8%) patients after CTSy and in 6 of 64 (9.4%) patients after ETS. As the most common side effect, temporary compensatory sweating, predominantly on the trunk, was reported by 16 of 68 (23.5%) patients after CTSy and 18 of 64 (28.1%) patients after ETS. Pneumothoraces developed during the surgical intervention in 26.6%, which were treated adequately by inserting a drain. Conclusion: For patients with severe palmar hyperhidrosis, CTSy and ETS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit. Recurrent sweating is slightly more common and more pronounced after CTSy than after ETS. However, a higher rate of major complications is seen in the case of ETS.