Management of essential hyperhidrosis of upper limbs by radiofrequency thermocoagulation of second thoracic ganglion

IntroductionEssential hyperhidrosis is an idiopathic condition characterized by markedly excessive sweating especially in the hands.ObjectiveThis study was done to evaluate the functional results of radiofrequency thermocoagulation of T2 ganglion in 10 patients suffered from essential hyperhidrosis of both upper limbs.MethodsThis retrospective study was carried out on 10 patients suffered from essential hyperhidrosis of both upper limbs. The male to female ratio was 2 to 3 (4 males and 6 females) and their ages ranged from 16 to 28 years. Simultaneous palmar and plantar sweating was present in five patients (50%), simultaneous palmar and craniofacial hyperhidrosis in two patients (20%), and simultaneous palmar and axillary hyperhidrosis in one patient (10%), while palmar hyperhidrosis alone was found only in two patients (20%). All cases underwent surgery in the form of radiofrequency thermocoagulation (RFT) of T2 on both sides under local anesthesia and sedation using C-arm radiological guidance. Mean postoperative follow up examination period was 24 months.ResultsThere was no operative mortality. Pneumothorax occurred on left side in one patient. Transient partial Horner's syndrome occurred on the right side in another patient. Postoperatively, 9 patients (90%) had clinical improvement of their palmar sweating. The last patient had partial improvement on right side and no improvement on the left side. The operation was repeated in one case with recurrence on the right side who improved. At the last follow up, excellent results were obtained in 90% of limbs, fair results in 5% of limbs, and poor results in 5% of limbs.ConclusionThe results of this study indicate that second thoracic ganglionectomy and sympathectomy performed with the use of percutaneous RFT is a very effective treatment for palmar hyperhidrosis that provide excellent immediate and long-term results as well as a low complication rate.