Transthoracic endoscopic sympathectomy for craniofacial hyperhidrosis: Analysis of 46 cases

Background and Purpose: Craniofacial hyperhidrosis may result in social pho bia and has a strong negative impact on the quality of life. The traditiona l therapeutic options are psychotherapy and pharmacologic treatment, but th ese often fail. We wished to investigate whether transthoracic endoscopic s ympathectomy (TES) of the lower part of the stellate ganglion is efficient and safe in the treatment of craniofacial hyperhidrosis. Patients and Methods: Between July 1995 and September 1999, a total of 21 m en and 25 women with a mean age of 41.2 years (range 22-58 years) underwent TES for craniofacial hyperhidrosis. All patients were placed in a semisitt ing position under single-lumen intubated anesthesia. We ablated the lower part of the stellate ganglion at the second rib using a storz 8-mm 0 degree s thoracoscope via one 0.8-cm incision just below each axilla, Questionnair es were sent to all patients postoperatively, Results: Among these 46 patients, 92 sympathectomies were performed, Usuall y, TES was accomplished within 15 minutes (range 7-20 minutes), The surgica l complications were minimal: one segmental atelectasis of the lung (2%), T here was no surgical mortality, With a mean postoperative follow-up of 32.1 months (range 3-51 months), the results of TES were highly satisfactory in most patients although 37 (80%) developed compensatory sweating of the tru nk and lower limbs, the distribution being the axillae in 15 (33%), back in 36 (78%), lower chest and abdomen in 22 (48%), lower limbs in 34 (74%) and sole in 1, The recurrence rates of craniofacial hyperhidrosis were 0 in th e first and the second years and 2% each in the third and fourth years. Conclusion: Transthoracic endoscopic sympathectomy is a safe and effective method for treating craniofacial hyperhidrosis.