Sympathetic block by metal clips may be a reversible operation

Area of Science:

• Thoracic surgery
• Neurosurgery
• Histopathology

Background:

• Thoracoscopic sympathectomy is a common treatment for primary hyperhidrosis and facial blushing.
• While effective, side effects like compensatory sweating are frequent.
• Surgical techniques, including sympathetic chain clipping, vary, with clip application offering potential reversibility.

Purpose of the Study:

• To investigate the histological reversibility of sympathetic nerve damage after clip removal in a sheep model.
• To compare conventional and immunohistochemical staining methods for assessing nerve damage.

Main Methods:

• Thoracoscopic clipping of the sympathetic trunk in adult sheep, with clip removal after 7 days.
• Harvesting sympathetic trunks at 4 and 12 weeks post-removal for analysis.
• Utilizing conventional and immunohistochemical stains (S100, neurofilament protein, synaptophysin) for histological evaluation.

Main Results:

• Severe neural damage was observed 4 weeks after clip removal using both staining methods.
• Marked decrease in histological changes was noted by 12 weeks post-removal.
• Conventional histology showed near-normalization at the 12-week mark.

Conclusions:

• Metal clips applied to the sympathetic chain cause significant, visible histological damage up to 4 weeks post-removal.
• The observed decrease in damage by 12 weeks suggests potential reversibility of the procedure.
• Further studies are needed to confirm physiological reversibility and the correlation between nerve trauma duration and clip application time.