Management of essential hyperhidrosis of upper limbs by radiofrequency thermocoagulation of second thoracic ganglion

Peer review under responsibility of Alexandria University Faculty of Medicine

Figures & data

Table 1 Extent of hyperhidrosis, extent of RFT and outcome of cases.

Extent of hyperhidrosis	No.	Extent of RFT	Outcome
			Palmar	Planter	Facial	Axillary
Palmar	2	T2	1 Excellent
			1 Fair + poor
Palmar + planter	5	T2	5 Excellent	1 Excellent
				2 Fair
				2 Poor
Palmar + facial	2	T2	2 Excellent		2 Excellent
Palmar + axillary	1	T2 + T3	1 Excellent			1 Excellent
Total	10		10	5	2	1

One patient with palmar and planter hyperhidrosis had hyperhidrosis over all his body.

Figure 1 Cross section at the level of second thoracic ganglion shows the entry point (L2), direction and depth of the probe M2 = mid point between the second and third dorsal spinous processes.²²

Figure 2 Radiological placement of electrode for RFT of T2 ganglion. (A) The electrode is initially placed adjacent to the T2–T3 interspace. (B) The electrode is placed alongside the T3 vertebral body beneath the head of the second rib.

Figure 3 Radiological placement of electrode for RFT of T2 ganglion. (A) Lateral view showing the electrode is placed at the mid vertebral body of T2. (B) P–A view showing the electrode is placed alongside the T3 vertebral body.

Figure 4 Right palmar flushing and sweating during RFT (stimulation mode) of right T2 ganglion.

Figure 5 The right hand is dry and flushed after the completion of RFT of right T2 ganglion.

Table 2 Summary data of 10 patients with essential hyperhidrosis who underwent RFT of T2 ganglion.

No.	Age	Sex	Extent of hyperhidrosis	No. of RFT lesions		Operative time in minutes	Complications	Outcome (relief of hyperhidrosis)			Follow up period in months
								Excellent	Fair	poor
				Right side	Left side
1	19	F	Palm and sole	4 Lesions	3 Lesions	45 min		Both sides			12 months
2	28	M	Palm and craniofacial	3 Lesions	2 Lesions	40 min		Both sides			26 months
3	21	F	Palm and sole	3 Lesions	2 Lesions	35 min		Both sides			23 months
4	20	M	Palm and axilla	4 Lesions	2 Lesions	40 min	Partial right Horner^’s syndrome	Both sides			36 months
5	19	F	Palm	4 Lesions	4 Lesions	50 min	Left side Pneumothorax		Right side	left side	25 months
6	21	M	Palm, sole and all body	4 Lesions	2 Lesions	45 min		Both sides			23 months
7	23	F	Palm and sole	3 Lesions/4 lesions	3 Lesions	40 min	Recurrence on right side	Both sides			15 months
8	19	M	Palm and craniofacial	3 Lesions	3 Lesions	40 min		Both sides			30 months
9	24	F	Palm and sole	2 Lesions	2 Lesions	30 min		Both sides			24 months
10	16	F	Palm	3 Lesions	3 Lesions	45 min		Both sides			30 months

Patient number 7 had recurrence on the right side after 12 months, the operation was repeated and the patient had excellent result during 15 months after the second operation.