1
|
Zhang H, Wang J, Liu J, Cao Z, Liu X, Jin H, Liu W, Xue Z, Yang N, Li C, Wang X. Fully neuroendoscopic resection of cerebellopontine angle tumors through a retrosigmoid approach: a retrospective single-center study. Neurosurg Rev 2023; 47:14. [PMID: 38102367 DOI: 10.1007/s10143-023-02244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The objective of this study is to preliminarily investigate the surgical safety, efficacy, techniques, and clinical value of fully neuroendoscopic surgery for the resection of cerebellopontine angle (CPA) tumors via a retrosigmoid approach. The clinical data of 47 cerebellopontine angle area (CPA) tumors that were treated by full neuroendoscopic surgery from June 2014 to June 2023 were retrospectively analyzed. The efficacy and advantages of the surgical techniques were evaluated based on indicators such as duration of the surgery, neuroendoscopic techniques, intraoperative integrity of nerves and blood vessels, extent of tumor resection, outcomes or postoperative symptoms, and incidence of complications. The 47 cases of cerebellopontine angle tumors include 34 cases of epidermoid cysts, 7 cases of vestibular schwannomas, and 6 cases of meningiomas. All patients underwent fully neuroendoscopic surgery. Twenty tumors were removed using the one-surgeon two-hands technique, and 27 tumors were removed using the two-surgeons four-hands technique. The anatomical integrity of the affected cranial nerves was preserved in all 47 cases. None of the patients suffered a postoperative hemorrhage, cerebrospinal fluid leak, and aseptic or septic meningitis, or died. The rate of total tumor resection was 72.3% (34/47), and the symptom improvement rate was 89.4% (42/47). All patients were followed up for 2 to 12 months, and none died nor showed any signs of tumor recurrence. By analyzing 47 fully neuroendoscopic resections of CPA tumors using the posterior sigmoid sinus approach in our center, we believe that such method allows complete, safe, and effective resection of CPA tumors and is thereby worthy of clinical promotion.
Collapse
Affiliation(s)
- Hengrui Zhang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Jiwei Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Junzhi Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Zexin Cao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Xuchen Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Haoyong Jin
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Wenyu Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Zhiwei Xue
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Ning Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Chao Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China.
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China.
| | - Xinyu Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China.
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China.
| |
Collapse
|
2
|
Han Z, Rui M, Ni C, Zhu J, Xu L, Yao M. The success rate and associated risk factors of CT-guided percutaneous radiofrequency sympathectomy in the treatment of primary hyperhidrosis: A retrospective observational trial. J Clin Neurosci 2023; 118:81-89. [PMID: 37890198 DOI: 10.1016/j.jocn.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/29/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Zixin Han
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Min Rui
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chaobo Ni
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianjun Zhu
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Longsheng Xu
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
| |
Collapse
|
3
|
Han Z, Rui M, Zhang Z, Tang J, Xu L, Yao M. Development and Validation of a Nomogram to Predict Recurrence of Primary Hyperhidrosis after CT-guided Percutaneous Radiofrequency Sympathectomy. J Vasc Interv Radiol 2023; 34:1892-1900.e4. [PMID: 37549843 DOI: 10.1016/j.jvir.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To evaluate the recurrence rate of primary hyperhidrosis (PH) after computed tomography (CT)-guided radiofrequency sympathectomy (RFS) and identify risk factors associated with recurrence. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Zixin Han
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China; Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Min Rui
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhiqiang Zhang
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiayi Tang
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Longsheng Xu
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Yao
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China; Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
| |
Collapse
|
4
|
Zhang L, Xu SS, Liu XL, Zhao W, Ma Y, Huang B. Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis. Front Surg 2023; 10:1126596. [PMID: 37325414 PMCID: PMC10264635 DOI: 10.3389/fsurg.2023.1126596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand's exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient's daily activities and quality of life. Objective The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH. Methods A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation. Results Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05). Conclusion Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.
Collapse
Affiliation(s)
- Li Zhang
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Shuang-shuang Xu
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
- Graduate School, Bengbu Medical College, Bengbuy, China
| | - Xiao-lan Liu
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei Zhao
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Ma
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
- Graduate School, Bengbu Medical College, Bengbuy, China
| | - Bing Huang
- The Department of Anesthesiology and Pain Research Center, the First Affiliated Hospital of Jiaxing University, Jiaxing, China
| |
Collapse
|
5
|
Wu Y, Zhou Z, Zhang W, Tian S, Li C, He F, Chen G. Percutaneous Radiofrequency Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Case-Controlled Study of Rib-Based Anatomical Targeting. J Vasc Interv Radiol 2023; 34:108-115. [PMID: 36182001 DOI: 10.1016/j.jvir.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE 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). MATERIALS AND METHODS 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. RESULTS 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). CONCLUSIONS RF sympatholysis targeting the lateral border of the fourth rib had higher efficacy, better quality of life, and higher patient satisfaction.
Collapse
Affiliation(s)
- Yue Wu
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - ZhenFeng Zhou
- Department of Anesthesia and Pain Management, The Affiliated Women's Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Weibo Zhang
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Suming Tian
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Chunye Li
- Department of Pain Management, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Feifang He
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China
| | - Gang Chen
- Department of Anesthesia and Pain Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, Hangzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
6
|
De Bie FR, Mathis-Perry T, Zimmerman M, Rhodes K, Laje P. Long-term outcomes of bilateral thoracoscopic T3 sympathectomy for primary focal hyperhidrosis in children. J Pediatr Surg 2023; 58:41-44. [PMID: 36344285 DOI: 10.1016/j.jpedsurg.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Felix R De Bie
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Tameyah Mathis-Perry
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Melanie Zimmerman
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kali Rhodes
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
7
|
Computed Tomography-Guided Percutaneous T4 Thoracic Sympathetic Radiofrequency Thermocoagulation for Primary Palmar Hyperhidrosis: A Retrospective Observational Trial. Cardiovasc Intervent Radiol 2023; 46:80-88. [PMID: 36316494 DOI: 10.1007/s00270-022-03305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the efficacy, safety, and patient satisfaction of computed tomography (CT)-guided percutaneous T4 thoracic sympathetic radiofrequency thermocoagulation (RFT) for the treatment of primary palmar hyperhidrosis (PPHH). MATERIALS AND METHODS A total of 158 patients who underwent bilateral thoracic sympathetic RFT at the T4 level were analysed. Hyperhidrosis Severity Scale (HDSS), Dermatologic Quality of Life Index (DLQI), patient satisfaction, and adverse events were evaluated within 12 months after RFT. RESULTS The mean age of the patients was 25.27 years, and 95 (60.1%) were females. The technical success, defined as planned needle placement and completion of RFT, was 99.4%. After the procedure, 243 hands (77.4%) were completely dry; and 58 hands (18.4%) were partially dry. From before RFT to 12 months after RFT, the proportion of hands with the HDSS grades 3 and 4 from 100% decreased to 31.9%; and that with the DLQI scores D and E from 100% decreased to 4.0% (P < .001). The clinical success rate was 76.6%, and the patient satisfaction rate was 80.8% at 12 months after RFT. During the procedures, there was unilateral local bleeding in two patients (0.6%) and bradycardia in five patients (3.2%); after the procedures, unilateral pneumothorax occurred in 15 patients (4.7%) and closed thoracic drainage was performed in two patients (0.6%); thoracic neuralgia occurred in 24 patients (15.2%). The incidence of compensatory hyperhidrosis (CH) 12 months after RFT was 15.2%. CONCLUSIONS CT-guided percutaneous T4 thoracic sympathetic RFT is safe, effective, and minimally invasive for the treatment of PPHH. LEVEL OF EVIDENCE Level 2 observational study with dramatic effect.
Collapse
|
8
|
Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis (2021 version). Chin Med J (Engl) 2022; 135:1264-1271. [PMID: 35830261 PMCID: PMC9433061 DOI: 10.1097/cm9.0000000000002198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’ social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.
Collapse
|
9
|
Andresen JR, Scheer F, Schlöricke E, Andresen R. CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects. ROFO-FORTSCHR RONTG 2020; 193:574-581. [PMID: 33348382 DOI: 10.1055/a-1299-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of the present study was to evaluate the benefit of a thoracic, computed tomography-guided sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis of the hands. In addition, the influence of the amount and distribution of the administered sympathicolytic agent was to be assessed. PATIENTS AND METHODS Retrospectively, 78 patients [13 (16.7 %) men, mean age 31.2 ± 9 years and 65 (83.3 %) women, mean age 34.2 ± 12 years], who had been treated using CTSy, were included in the study. The indication for treatment was primary focal palmar hyperhidrosis grade II and grade III after exhaustion of all conservative treatment options and a continued high level of suffering. CTSy was performed after establishing the entry plane at the level of the intervertebral space T2 / T3 via a dorsolateral approach using a 22-G coaxial needle. On average 5 (2-10) ml of a sympathicolytic mixture (10 ml consisting of 8 ml 96 % alcohol, 1.6 ml 0.5 % Carbostesin and 0.4 ml 0.9 % NaCl solution, with added amounts of contrast medium) were instilled. The volume of distribution of the sympathicolytic agent was determined in craniocaudal direction using CT images. The patients evaluated their sense of discomfort preinterventionally, 2 days postinterventionally, and 6 and 12 months after the intervention, on the basis of a Dermatology life Quality Index (DLQI) as well as the side effects that occurred. RESULTS The technical success rate of CTSy was 100 %. No major complications occurred. The interventions performed led to a significant reduction (p < 0.001) in the preinterventional sense of discomfort 2 days, 6 and 12 months after CTSy. As the most common side effect, compensatory sweating was reported by 16/78 (20.5 %) of the patients over the further course. In all of these patients, the volume of sympathicolytic agent administered was below 5 ml. In no case did the sympathicolytic agent extend caudally beyond the base plate of Th 3. No compensatory sweating of the back was observed in 5/78 (6.4 %) patients; here the sympathicolytic volume was above 5 ml and extended significantly caudally below the baseplate of T3.Transient miosis and ptosis was found in 8/78 (10.3 %) patients. In all of these patients, the volume of sympathicolytic agent administered was above 5 ml and it extended markedly cranially beyond the upper plate of T2. A mild to moderate recurrent sweating developed in 35/78 (44.9 %) patients, which was more marked if the volume of sympathicolytic administered was below 5 ml and slightly more pronounced on the left than on the right. Given a high level of satisfaction overall, 71/78 (91.0 %) patients said that they would undergo the intervention again. CONCLUSION For patients with primary, focal palmar hyperhidrosis CTSy represents a therapeutic option that offers good benefit and has few side effects. The amount and spatial distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects. KEY POINTS · CT-assisted thoracic sympathicolysis is a minimally invasive, low-complication therapy for treatment of severe forms of primary hyperhidrosis palmaris.. · CT-assisted thoracic sympathicolysis can usually be performed on an outpatient basis.. · The quantity and local distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects.. CITATION FORMAT · Andresen J, Scheer F, Schlöricke E et al. CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects. Fortschr Röntgenstr 2021; 193: 574 - 581.
Collapse
Affiliation(s)
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Erik Schlöricke
- Department of Visceral, Thoracic and Vascular Surgery, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Heide, Germany
| |
Collapse
|
10
|
Hasimoto FN, Cataneo DC, Hasimoto EN, Ximenes AMG, Cataneo AJM. Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis. Clin Auton Res 2019; 30:111-120. [PMID: 31552511 DOI: 10.1007/s10286-019-00640-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH). METHODS Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment. RESULTS Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF. CONCLUSIONS RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.
Collapse
Affiliation(s)
- Fabio Nishida Hasimoto
- Post-Graduation Program on General Basis of Surgery, School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Daniele Cristina Cataneo
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Erica Nishida Hasimoto
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Aglaia Moreira Garcia Ximenes
- Post-Graduation Program on Medicine, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Antônio José Maria Cataneo
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil.
| |
Collapse
|
11
|
Lima SO, Santos RS, Moura AMM, Neto EG, Andrade RLB, Valido AD, dos Santos VF, Mendonça AKRH. A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis. Int J Dermatol 2019; 58:982-986. [DOI: 10.1111/ijd.14470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 02/19/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia O. Lima
- Master's and Doctorate Program: Health and Environment Tiradentes University Aracaju Brazil
| | | | | | | | | | - Arthur D. Valido
- Department of Medicine Federal University of Sergipe Aracaju Brazil
| | | | - Ana K. R. H. Mendonça
- Master's and Doctorate Program: Health and Environment Tiradentes University Aracaju Brazil
| |
Collapse
|
12
|
Lima SO, Santos RS, Varjao LL. Reply. J Vasc Surg 2018; 68:316. [PMID: 29937039 DOI: 10.1016/j.jvs.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia Oliveira Lima
- Programa de Mestrado e Doutorado Saúde e Ambiente, Universidade Tiradentes, Aracaju, Brazil
| | - Rafael Silva Santos
- Institute for Technology and Research, Laboratory of Nanotechnology and Nanomedicine, Aracaju, Brazil
| | - Lucas Leal Varjao
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Brazil
| |
Collapse
|
13
|
Chick JFB, Srinivasa RN. Regarding "Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis". J Vasc Surg 2018; 68:315-316. [PMID: 29937038 DOI: 10.1016/j.jvs.2017.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich; Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, Va
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| |
Collapse
|
14
|
Brock M, Frangakis C, Georgiades CS. CT-Guided, Percutaneous Ethanol Sympatholysis for Primary Hyperhidrosis. Cardiovasc Intervent Radiol 2017; 41:477-482. [DOI: 10.1007/s00270-017-1806-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/21/2017] [Indexed: 11/24/2022]
|