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. 2023 May 31:10:1126596.
doi: 10.3389/fsurg.2023.1126596. eCollection 2023.

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

Li Zhang  1 , Shuang-Shuang Xu  1   2 , Xiao-Lan Liu  1   3 , Wei Zhao  1   3 , Ying Ma  1   2 , Bing Huang  1
Affiliations

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

Li Zhang et al. Front Surg. .

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.

Keywords: autonomic nerve block; hyperhidrosis; nerve block; palmar; radiofrequency therapy; sympathetic.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Under CT guidance, the needle tip reaches the predetermined target point (indicated by the red arrow) along the designed puncture path.
Figure 2
Figure 2
Successful puncture with lidocaine test. 2.5 ml of absolute alcohol (each 1 ml contains 0.9 ml of absolute alcohol and 0.1 ml of 30% iohexol) is injected on both sides, as shown by the red arrow in the figure.
Figure 3
Figure 3
The distribution of absolute alcohol on both sides after three-dimensional CT reconstruction, which wraps around the small head of the 4th rib and the lateral edge of the 4th vertebral body, as indicated by the red arrow in the figure.
Figure 4
Figure 4
CT-guided puncture reaching the predetermined target point along the designed path (indicated by the red arrow).
Figure 5
Figure 5
After the three-dimensional reconstruction of CT, the needle tips on both sides reach the anterior superior edge of the 4th rib head and the lateral wall of the T4 vertebral body. (indicated by the red arrow).
Figure 6
Figure 6
The thoracic sympathetic nerve chain is observed to cling to the pleura in front of the small head of ribs (indicated by the black arrow), rather than in the paraspinal space.
See this image and copyright information in PMC

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