Percutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis

doi:10.1016/j.jvir.2017.02.025

Journal of Vascular and Interventional Radiology

Volume 28, Issue 6, June 2017, Pages 877-885

https://doi.org/10.1016/j.jvir.2017.02.025 Get rights and content

Abstract

Purpose

To evaluate the benefits of computed tomography (CT)–guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy.

Materials and Methods

A total of 139 procedures in 108 patients (mean age, 29.89 y ± 10.94), including 50 men and 58 women, with PPHH and therapy-resistance of nonsurgical treatments were retrospectively analyzed. Treatment was performed bilaterally at T2, T3, and T4 levels, reaching 90°C during 8 minutes. Technical success, immediate efficacy, and presence of complications were analyzed. For follow-up, the Hyperhidrosis Disease Severity Scale was used to evaluate the hyperhidrosis before, at one month, and in the long-term through a survey of 42 patients. Patients' satisfaction and complications were also recorded.

Results

The technical success rate was 98.56%. The increase in palmar skin temperature was 4.88°C ± 1.85. A total of 85.3% of participants had completely dry hands immediately after treatment. The mean follow-up time was 41.34 months (range, 6–62 mo). One month after treatment, the response rate was 77.38% (P < .001). At long-term follow-up, the response rate was 69.04% (P < .001). Two major complications were observed (1.8%), 52.38% of patients were satisfied, and 59.52% of patients presented compensatory hyperhidrosis at long-term follow-up.

Conclusions

Percutaneous CT–guided sympathicolysis is a safe and effective technique for the treatment of PPHH and can be considered as a second choice in patients in whom other nonsurgical therapeutic options have failed, despite the compensatory hyperhidrosis rates.

Section snippets

Patient Selection

From March 2010 to September 2015, patients with severe PPHH were diagnosed and treated by the Department of Dermatology of a single institution. The diagnostic criteria for PPHH were excessive sweating of more than 6 months’ duration, bilateral and symmetric involvement of the eccrine glands, appearance of the symptoms before the age of 25 years, and positive family history (13). The participation criteria for the CT–guided percutaneous RF sympathicolysis technique included patients with PPHH

Technical Success and Radiation Dose Data

A total number of 139 procedures in 108 patients were analyzed. The procedure was performed successfully in almost all patients, with a technical success rate of 98.56%. In two cases, the procedure could not be performed at one level because of pain during RF administration (Table 1). The mean dose–length product of the procedure was 1,274.28 mGy·cm ± 1,223.77, and the mean effective dose was 17.06 mSv ± 17.14.

Immediate Efficacy

Of the 108 patients, the quantitative analysis data for 11 patients and qualitative

Discussion

The present study demonstrates that CT–guided percutaneous RF sympathicolysis of T2, T3, and T4 levels for the treatment of PPHH is a safe and effective procedure. Results showed an initial success rate of 98.56%, similar to the success rates of surgical intervention in the literature, which are reported to be between 95% and 97.4% 8, 9. Quantitative and qualitative assessment of the immediate efficacy of percutaneous treatment showed good results, with an average increase in palmar skin

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Cited by (18)

The success rate and associated risk factors of CT-guided percutaneous radiofrequency sympathectomy in the treatment of primary hyperhidrosis: A retrospective observational trial
2023, Journal of Clinical Neuroscience
The aim of this study was to investigate the success rate of surgical technique and associated risk factors based on the follow-up of patients who underwent CT-guided percutaneous radiofrequency sympathectomy (RFS) to treat primary hyperhidrosis (PH).
370 patients who underwent RFS for PH treatment between January 2018 and April 2022 were enrolled. Patients responded to a questionnaire and telephone follow-up on the effects of treatment and their electronic medical records and imaging findings were reviewed. Logistic regression was performed to identify risk factors related to the success rate of surgical technique.
A temperature difference ≥2 °C before and after procedure was defined as a successful surgical technique. Among the 370 patients (740 sides), 637 sides had successful RFS, and the technical success rate was 86.1 %. Immediately after procedure, 636 sides (85.9 %) were completely dry, 64 (8.7 %) were partially dry, and 40 (5.4 %) were still wet. During the longest follow-up period (54 months), 103 patients relapsed. The median hyperhidrosis disease severity scale score on both sides decreased from 4 to 1 after RFS. According to logistic regression analysis, only the pre-post pulse index was associated with the success rate of surgical technique (odds ratio, 1.14; 95 % confidence interval, 1.06–1.23; p = 0.0004).
We observed that the immediate efficiency and success rate of surgical technique after RFS for PH treatment were relatively high, although there is a possibility of recurrence in the long term. In general, RFS is a safe and effective procedure for alleviating the symptoms of patients with hyperhidrosis.
Development and Validation of a Nomogram to Predict Recurrence of Primary Hyperhidrosis after CT-guided Percutaneous Radiofrequency Sympathectomy
2023, Journal of Vascular and Interventional Radiology
To evaluate the recurrence rate of primary hyperhidrosis (PH) after computed tomography (CT)-guided radiofrequency sympathectomy (RFS) and identify risk factors associated with recurrence.
A total of 290 patients with PH who underwent CT-guided RFS were included in this retrospective cohort study. The electronic medical record was reviewed for patients’ information and procedural parameters. Follow-ups were conducted for recurrence rate, and Hyperhidrosis Disease Severity Scale was used to assess presence or absence of recurrence. Stepwise regression and the least absolute shrinkage and selection operator regression algorithms were used for feature selection.
The recurrence rate 1 year after procedure was 17.6%. Male (hazard ratio [HR], 2.35; 95% confidence interval [CI], 1.08–5.15), low postoperative palm or foot temperature (HR, 0.77; 95% CI, 0.60–0.98), high postoperative heart rate (HR, 1.06; 95% CI, 1.02–1.10), low preoperative and postoperative hospital anxiety and depression score difference (HR, 0.59; 95% CI, 0.43–0.80), and the absence of compensatory hyperhidrosis immediately after procedure (HR, 0.46; 95% CI, 0.22–0.98) were established as independent factors affecting prognosis. A nomogram was built accordingly. The C indices of the training and testing sets were 0.773 and 0.659, respectively.
Follow-up results showed that the recurrence rate of PH treated with CT-guided RFS was low. This study constructed and validated a nomogram to predict the recurrence of PH 1 year after CT-guided RFS, which is convenient for interventionalists to evaluate accurately the prognosis of patients postoperatively and to identify high-risk patients who need more active treatment.
Long-term outcomes of bilateral thoracoscopic T3 sympathectomy for primary focal hyperhidrosis in children
2023, Journal of Pediatric Surgery
Citation Excerpt :
Considering our excellent short- and long-term outcomes in a strictly pediatric population, we feel justified to continue using our current surgical approach. Novel techniques such as CT-guided sympathicolysis, have been proposed for primary palmar hyperhidrosis, however hold higher rates of CS and recurrence, however may avoid problems related to thoracoscopy such as postoperative pain [12,13]. We herein present the long-term outcomes of our pediatric patient population that underwent thoracoscopic bilateral T3 sympathectomy for focal palmar hyperhidrosis.
Thoracoscopic bilateral T3 sympathectomy for primary focal palmar hyperhidrosis in children has excellent short-term outcomes. However, data in the literature, on the long-term outcomes of the operation are scarce.
We conducted a retrospective institutional review of all children and adolescents undergoing T3 bilateral thoracoscopic sympathectomy for primary focal palmar hyperhidrosis between June 2013 and October 2020. We composed a quality of life (QoL) questionnaire evaluating the patient's perception of how much the hyperhidrosis affected their daily life in multiple domains. The questionnaire was completed before the operation and at every postoperative follow-up visit.
We operated on 58 patients with a median age of 15 (6–25) years. There were no intraoperative or postoperative complications, and all patients had immediate complete postoperative resolution of their palmar hyperhidrosis. Fifty-three patients (91.4%) had long-term follow-up data available with a median of 2.5 (range 0.1–7.5) years. Two patients (3.4%) experienced recurrence of their palmar hyperhidrosis. Nine patients (15.5%) experienced compensatory hyperhidrosis and required occasional medical management with oral anticholinergics. Two patients reported regretting having undergone the operation. Overall, the mean QoL score improved remarkably, from 42/100 before the operation to 92/100 at 1 month, 89/100 at six months to a year, 97/100 between two and four years, and 80/100 ≥ 5 years after the operation.
Thoracoscopic bilateral T3 sympathectomy has a high success rate for primary palmar hyperhidrosis in children in the mid- to long-term. Compensatory sweating and recurrence can occur years after the operation, so long-term follow up is mandatory.
IV.
Percutaneous Radiofrequency Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Case-Controlled Study of Rib-Based Anatomical Targeting
2023, Journal of Vascular and Interventional Radiology
Citation Excerpt :
The aforementioned information and data were obtained from medical records, postprocedural outpatient follow-up visits, and questionnaires. According to the results reported by García-Barquín et al (15), the percentage of patients with severe PPHH (HDSS Grades III and IV) was 90.5% before treatment; however, it significantly decreased to 32.1% after percutaneous CT-guided sympathicolysis with RF. If rib-based percutaneous RF sympatholysis at different anatomic targets achieved the same treatment effect, a 2-tailed chi-square test was performed, and it was estimated that 32 patients were required to provide 90% power, with a Type I error probability of 0.05.
To compare the efficacy, adverse reactions, quality of life, and patient satisfaction of percutaneous radiofrequency (RF) thoracic sympatholysis at different rib-based anatomic targets for primary palmar hyperhidrosis (PPHH).
Patients with PPHH were divided according to the target, namely, the upper edge (Group U) and lateral border (Group L) of the fourth rib; there were 30 patients (mean age, 24.9 years; women, 31, 51.7%) and 60 cases in each group. The Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI) were assessed.
From before RF sympatholysis to 12 months after, the proportion of patients with HDSS Grades III and IV (100%–26.7%) and the DLQI (19.78 ± 5.08 to 4.98 ± 4.18) decreased significantly (P < .001). At 3, 6, and 12 months after RF, the HDSS grades were better in Group L than in Group U (P = .005, .002, and .004). At 6 and 12 months after RF, the DLQI in Group L was lower than that in Group U (P = .012 and .016), and at 1, 6, and 12 months after RF, patient satisfaction was higher than that in Group U (P = .025, .014, and .009). Adverse events were mild; 8 patients (13.3%) demonstrated compensatory hyperhidrosis at 12 months after RF, and there was no difference between the 2 groups (P = .448); neuralgia and pneumothorax also did not differ (P = .522 and .643).
RF sympatholysis targeting the lateral border of the fourth rib had higher efficacy, better quality of life, and higher patient satisfaction.
Regarding “Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis”
2018, Journal of Vascular Surgery
Reply
2018, Journal of Vascular Surgery

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: None of the authors have identified a conflict of interest.

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Clinical StudyPercutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Patient Selection

Technical Success and Radiation Dose Data

Immediate Efficacy

Discussion

Surgeon

Dermatol Clin

Surg Neurol

J Am Acad Dermatol

J Clin Neurosci

J Am Acad Dermatol

Am J Surg

Surgery

Management of hyperhidrosis

Clin Cosmet Invest Dermatol

Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins

Toxins