CT-guided Percutaneous Ethanol Sympatholysis for Hyperhidrosis: How I Do It

Area of Science:

• Neurology
• Interventional Radiology
• Dermatology

Background:

• Hyperhidrosis, excessive sweating due to sympathetic nerve overactivity, affects 1-1.6% of the population.
• Conservative treatments are often insufficient for severe facial, axillary, or palmar hyperhidrosis (grades 3-4).
• Surgical sympathectomy and percutaneous sympatholysis offer definitive treatment by targeting thoracic paravertebral ganglia.

Purpose of the Study:

• To review the technique of CT-guided percutaneous ethanol sympatholysis for severe hyperhidrosis.
• To discuss patient selection, procedural risks, and treatment outcomes.
• To evaluate the long-term efficacy and complication profile of this intervention.

Main Methods:

• Detailed step-by-step description of CT-guided percutaneous ethanol sympatholysis.
• Targeting thoracic vertebral levels T2, T3, and T4 paravertebral ganglia.
• Review of patient selection criteria, potential complications, and outcomes.

Main Results:

• Over 90% of patients achieve immediate symptom resolution.
• Symptom recurrence is reported in up to 40% within 6 months.
• Long-term (over 6 months) hyperhidrosis-free probability is approximately 60%.

Conclusions:

• CT-guided percutaneous ethanol sympatholysis is an effective intervention for severe hyperhidrosis unresponsive to conservative measures.
• While immediate results are excellent, long-term recurrence necessitates careful patient counseling.
• Significant procedural risks, including compensatory hyperhidrosis (15%), Horner syndrome (8%), and pneumothorax (5%), must be considered.