[Image-guided pain therapy. Sympathicolysis]

Area of Science:

• Interventional Radiology
• Autonomic Nervous System
• Pain Management

Background:

• Sympathetic neurons in the sympathetic trunk ganglia are targeted for therapeutic reduction of sympathicotonia.
• Percutaneous sympathicolysis (SL), a minimally invasive technique, has evolved over a century and is now integral to interventional radiology.
• Established indications for SL include hyperhidrosis, critical limb ischemia, and complex regional pain syndrome.

Purpose of the Study:

• To summarize the established indications and therapeutic principles of image-guided percutaneous sympathicolysis.
• To highlight the role of computed tomography (CT) guidance in the procedure.
• To discuss the outcomes and potential complications of sympathicolysis.

Main Methods:

• Computed tomography (CT) is the standard imaging modality for precise needle placement.
• Ethanol is used for chemical lysis, primarily targeting unmyelinated autonomic axons.
• Iodine-containing contrast medium visualizes ethanol distribution during application.

Main Results:

• SL effectively treats hyperhidrosis by targeting sweat-controlling sympathetic efferent neurons.
• Vasodilation and improved limb perfusion are achieved in critical limb ischemia by reducing sympathetic tone.
• Pain relief in complex regional pain syndrome is attributed to the elimination of afferent sensory fibers.

Conclusions:

• CT guidance has significantly reduced major complications associated with percutaneous sympathicolysis.
• While generally safe, specific risks include syncope (thoracic SL) and ureteral injury (lumbar SL).
• Minimally invasive, image-guided SL remains a valuable therapeutic option for specific autonomic and pain conditions.