Risk Factors Affecting the Outcomes of CT-Guided Radiofrequency Thermocoagulation of the T3 Sympathetic Nerve in the Treatment of Craniofacial Hyperhidrosis

Overview

Journal Ther Clin Risk Manag

Publisher Dove Medical Press

Date 2024 Aug 12

PMID 39131182

Authors

Hanrui Fan

Ping Xu

Enming Zhang

Xi Meng

Jianmei Xia

Yong Fei

Ming Yao

Affiliations

Soon will be listed here.

Abstract

Background: Current studies mostly suggest that hyperhidrosis is caused by relative sympathetic hyperactivity. Sympathetic radiofrequency thermocoagulation is widely used in clinics. Previous studies have demonstrated that surgery at T3 is effective and safe compared with higher levels, so craniofacial hyperhidrosis in our hospital is selected to be treated at T3. However, some patients pursue repeat medical treatment due to an increase in hyperhidrosis at the original site after surgery. Previous studies have demonstrated the significance of Perfusion index (PI) value in the recurrence of palmar hyperhidrosis, but there is no relevant study on craniofacial hyperhidrosis.

Methods: Clinical data from patients with craniofacial hyperhidrosis, who underwent T3 sympathetic radiofrequency thermocoagulation at Jiaxing First Hospital (Jiaxing, China) between January 1, 2018 and December 31, 2021, were analyzed. Recurrence in patients 1 year after surgery was recorded through a case search and telephone follow-up system that registered patient information. Clinical data were analyzed using binary logistic regression analysis to investigate risk factors associated with recurrence in patients with craniofacial hyperhidrosis 1 year after surgery.

Results: Of 83 patients included in the present study, 34 (40%) experienced increased craniofacial sweating 1 year after surgery. Results of univariate logistic regression analysis revealed that computed tomography (CT) scan count, increase in pulse index (PI) at the fingertips, and differences in forehead temperature were potential risk factors for postoperative recurrence in patients with craniofacial hyperhidrosis (p<0.2), and the results were consistent on both sides. Three potential risk factors were included in the multivariate logistic regression analysis and results revealed that the risk for recurrence was reduced by 48% (left side) and 67% (right side) for every 1 unit increase in PI value.

Conclusion: A small increase in PI was an independent risk factor for recurrence of hyperhidrosis in patients with craniofacial hyperhidrosis after undergoing T3 sympathetic radiofrequency thermocoagulation.

References

I-Hun Jeng E, Gravenstein N, Klodell C . Perfusion Index: An Indicator of Success During Endoscopic Thoracic Sympathectomy for Hyperhidrosis. Ann Thorac Surg. 2017; 104(2):426-430. DOI: 10.1016/j.athoracsur.2017.02.023. View

Zhang Z, Xia Z, Luo G, Yao M . Analysis of Efficacy and Factors Associated with Reccurence After Radiofrequency Thermocoagulation in Patients with Postherpetic Neuralgia: a Long-Term Retrospective and Clinical Follow-Up Study. Pain Ther. 2022; 11(3):971-985. PMC: 9314488. DOI: 10.1007/s40122-022-00412-x. View

Cerfolio R, De Campos J, Bryant A, Connery C, Miller D, DeCamp M . The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011; 91(5):1642-8. DOI: 10.1016/j.athoracsur.2011.01.105. View

Klodell C, Lobato E, Willert J, Gravenstein N . Oximetry-derived perfusion index for intraoperative identification of successful thoracic sympathectomy. Ann Thorac Surg. 2005; 80(2):467-70. DOI: 10.1016/j.athoracsur.2005.02.075. View

RAY B, Hinsey J, GEOHEGAN W . OBSERVATIONS ON THE DISTRIBUTION OF THE SYMPATHETIC NERVES TO THE PUPIL AND UPPER EXTREMITY AS DETERMINED BY STIMULATION OF THE ANTERIOR ROOTS IN MAN. Ann Surg. 1943; 118(4):647-55. PMC: 1617782. DOI: 10.1097/00000658-194310000-00013. View

Parashar K, Adlam T, Potts G . The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature. Am J Clin Dermatol. 2023; 24(2):187-198. PMC: 9838291. DOI: 10.1007/s40257-022-00743-7. View

Kopelman D, Hashmonai M, Assalia A, Bahous H . Primary palmar hyperhidrosis presenting with unilateral symptoms: a report of two cases and review of the literature. Cardiovasc Surg. 1998; 6(1):94-6. DOI: 10.1016/s0967-2109(97)00095-1. View

Shih C, Wu J, Lin M . Autonomic dysfunction in palmar hyperhidrosis. J Auton Nerv Syst. 1983; 8(1):33-43. DOI: 10.1016/0165-1838(83)90021-8. View

Pariser D . Incorporating diagnosis and treatment of hyperhidrosis into clinical practice. Dermatol Clin. 2014; 32(4):565-74. DOI: 10.1016/j.det.2014.06.010. View

10.

Chen J, Liu Y, Yang J, Hu J, Peng J, Gu L . Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery. 2019; 166(6):1092-1098. DOI: 10.1016/j.surg.2019.05.039. View

11.

Lin C, Telaranta T . Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery. Ann Chir Gynaecol. 2001; 90(3):161-6. View

12.

Cho H, Lee D, Sung S . Anatomical variations of rami communicantes in the upper thoracic sympathetic trunk. Eur J Cardiothorac Surg. 2005; 27(2):320-4. DOI: 10.1016/j.ejcts.2004.10.057. View

13.

Kuang J, Luo G, Tao J, Xu M, Fu J, Zhao B . Risk Factors Affecting the Outcomes of CT-Guided Radiofrequency Thermocoagulation of Thoracic Sympathetic Nerve in the Treatment of Primary Palm Hyperhidrosis. Pain Physician. 2022; 25(8):E1219-E1228. View

14.

Nawrocki S, Cha J . The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol. 2019; 81(3):657-666. DOI: 10.1016/j.jaad.2018.12.071. View

15.

Wang T, Xu S, He Q, Tao J, Ni H, Zhu J . Efficacy and Safety of Radiofrequency Thermocoagulation with Different Puncture Methods for Treatment of V1 Trigeminal Neuralgia: A Prospective Study. Pain Physician. 2021; 24(2):145-152. View

16.

Estevan F, Wolosker M, Wolosker N, Puech-Leao P . Epidemiologic analysis of prevalence of the hyperhidrosis. An Bras Dermatol. 2017; 92(5):630-634. PMC: 5674693. DOI: 10.1590/abd1806-4841.20175551. View

17.

Lin T, Kuo S, Chou M . Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery. 2002; 51(5 Suppl):S84-7. View

18.

Vannucci F, Araujo J . Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis. 2017; 9(Suppl 3):S178-S192. PMC: 5392541. DOI: 10.21037/jtd.2017.04.04. View

19.

Solish N, Bertucci V, Dansereau A, Hong H, Lynde C, Lupin M . A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg. 2007; 33(8):908-23. DOI: 10.1111/j.1524-4725.2007.33192.x. View

20.

Hasimoto F, Cataneo D, Hasimoto E, Ximenes A, Cataneo A . Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis. Clin Auton Res. 2019; 30(2):111-120. DOI: 10.1007/s10286-019-00640-w. View