Transthoracic endoscopic sympathectomy for craniofacial hyperhidrosis: analysis of 46 cases

Craniofacial hyperhidrosis may result in social phobia and has a strong negative impact on the quality of life. The traditional therapeutic options are psychotherapy and pharmacologic treatment, but these often fail. We wished to investigate whether transthoracic endoscopic sympathectomy (TES) of the lower part of the stellate ganglion is efficient and safe in the treatment of craniofacial hyperhidrosis.

Between July 1995 and September 1999, a total of 21 men 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 semisitting 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 degrees thoracoscope via one 0.8-cm incision just below each axilla. Questionnaires were sent to all patients postoperatively.

Among these 46 patients, 92 sympathectomies were performed. Usually, TES was accomplished within 15 minutes (range 7-20 minutes). The surgical complications were minimal: one segmental atelectasis of the lung (2%). There 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 trunk 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 the first and the second years and 2% each in the third and fourth years.

Transthoracic endoscopic sympathectomy is a safe and effective method for treating craniofacial hyperhidrosis.