Changes in hemodynamics of the carotid and middle cerebral arteries before and after endoscopic sympathectomy

The purpose of this study was to analyze the change in carotid and middle cerebral artery (MCA) hemodynamics before and after endoscopic upper thoracic sympathectomy in patients with palmar hyperhidrosis.


Patients who underwent T-2 sympathectomy demonstrated a significant increase in blood flow volume and flow velocities of the CAs and MCA, especially on the left side. Asymmetry of sympathetic influence on the hemodynamics of the CAs and MCA was noted.


http://thejns.org/doi/abs/10.3171/jns.1999.90.3.0463

abnormal peripheral vascular responses to temperature after sympathectomy

IS PREVIOUS THORACIC SYMPATHECTOMY A RISK FACTOR FOR EXERTIONAL HEAT STROKE?

Alan D.L. Sihoe, FRCSEd(CTh)^a,_*, Raymond W.T. Liu, MRCP^b,Alex K.L. Lee, MRCP^b, Chak-Wah Lam, FHKAM^b, Lik-Cheung Cheng, FRCS^ahttp://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

sympathectomies preclude possible treatments down the road

Sympathectomies used to be thought of as THE answer to CRPS/RSDS. Fortunately much has been learned over the last five or so years and most Doctors and Medical Centers no longer practice this procedure. Unfortunately though there are still pockets of resistance and they are still performed in some arenas in one form or another.

There are Drs who used to believe in this procedure and actually wrote articles supporting it and who have now learned they do not help but rather hurt the typical RSD patient. It takes great courage for a Dr to reverse such a major stand and we applaud that courage. Unfortunately because the internet is so vast their articles from many years ago supporting the treatment are still floating around to be quoted by unknowing Drs who will go ahead and perform the treatment. Of course this is not a problem singular to our community. We just have to make sure we spread the word on the correct treatments to every corner of the web.

They go by different names, Sympathectomy, Neurectomy, Ablation, burning or freezing the nerve, etc. but for most RSD patients have the same results. And like other surgical interventions, sympathectomies preclude possible treatments down the road that might use the same main nerve pathway.

http://www.rsdhope.org/Sh..._ID=155&PGCT_ID=3826

Nerve regeneration commonly occurs following both surgical or chemical ablation

This systematic review found only one small study (20 participants) of good methodological quality, which reported no significant difference between surgical and chemical sympathectomy for relieving neuropathic pain. Potentially serious complications of sympathectomy are well documented in the literature, and one (neuralgia) occurred in this study.

The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant.

http://www2.cochrane.org/reviews/en/ab002918.html

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 3, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available inThe Cochrane Library (ISSN 1464-780X).

Decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior cervical sympathetic ganglionectomy

"The reduced brain metabolism and consequently reduced cerebral perfusion in the late 

postsympathectomy period could account for reduction in CSF production (Bering3)."

"In support of the above statement we mention that on the late postsympathectomy (11 to 24 months) group of dogs besides the lowered CBF 

(31.36 ml/100 gm brain weight/minute) and MCP (79.3 mm NS) also a lowered MVP (46.5 mm NS) was found. These data indicate that cervicalsympathectomy has a profound and intricate effect on the dynamics of cerebrovascular fluids and probably, in the background of all observedphenomena, a decreased cerebral metabolism as a sympathectomy effect is the underlying cause. Correspondingly the cerebral metabolic rate ofoxygen (CMR O2) decreased to 2.94 and 2.43 ml of O2/IOO gm brain weight/ minute in the sympathectomized groups." 

"Decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior 

cervical sympathetic ganglionectomy."

http://archsurg.ama-assn.org/cgi/content/summary/90/3/418

Evaluation of Websites Built by Patients who Underwent Endoscopic Thoracic Sympathectomy - doctors are well aware of the many adverse effects and the complaints of patients after ETS

Results: The goals of these websites include 1.Warn potential victims not to undertake ETS. 2. Get ETS banned. 3. Get the medical boards to adopt a defined standard of what exactly constitutes informed consent. 4. Get ETS syndrome recognized as an "official" disability. 5. Get compensation paid to ETS sufferers. 6. Punish fraudulent doctors. 7. Research into a working reversal procedure. 7. Understand the path physiology of hyperhidrosis and CS. 8. Find treatments for side effects. 9. Obtain emotional support. Since these sufferers were deeply troubled by the side effects, all websites polled consistently held a high expectation toward the reversal procedure. Certain serious side effects were highly consistent among different web pages. By far the commonest complaint of the sufferers is compensatory sweating. 
From several self-reports it seems that the severity and extent of compensatory sweating may change even several years after ETS. Many complaints were about no sweat on face and neck. ETS surgery can cause a total inability to sweat from the nipple line up. Extremely dry hands were also a common problem. 
There were three self-reports about the result of reversal by removal of clamp, two patients found some improvement after this procedure, the other didn't. 
There were two self-reports about the result of reversal by removal of clamp, these two patients did not find any improvement after this procedure. 
There were five self-report about the result of reversal by the nerve graft. None of them was effective. 
One of the self-reports was made 3 years after the sural nerve graft, and the only effect was the recurrence of palmar hyperhidrosis. This patient also complained that the reversal procedure made his side effects worse. 
There were four self-reports about the result of reversal by the nerve graft, no one found this procedure 
to be effective. 
Discussion: Evaluation of these websites was helpful for the understanding of side effects after ETS. 
This kind of information is important for all physicians providing this service and all people preparing 
to undergo this treatment. 
Corresponding Author: Hsu Min-Huei - 701056@tmu.edu.tw 
MEDNET 2005 - New Tasks in Internet Use in Health Care

After the sympathectomy, the high night time excretion was clearly abolished

The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery a normal 6-sulphatoxymelatonin excretion with a peak in the excretion 
during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients...
http://www.ncbi.nlm.nih.gov/pubmed/16647807