MEDLINE + ABSTRACTS  SYMPATHOLYSIS




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Percutaneous phenol neurolysis of the lumbar sympathetic chain with computed tomography control.

[Lumbar sympathectomy in the aged subject : surgery or phenolization ?
Prospective study of early results].

Percutaneous lumbar sympathectomy : a comparison of radiofrequency denervation versus phenol neurolysis.

Percutaneous chemical lumbar sympathectomy with alcohol with computed tomography control.

[Thoracic sympathectomy by phenol injection under x-ray computed tomography.
Two initial results].

Percutaneous radiofrequency upper thoracic sympathectomy. 

[Percutaneous thoracic sympathectomy under x-ray computed tomographic control in hyperhidrosis and refractory ischemia. Apropos of 17 cases].

Endoscopic Sympathectomy.

Percutaneous epidural and nerve root block and percutaneous lumbar sympatholysis.

Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease.
 
 

Ann Radiol (Paris) 1984 Apr-May ;27(4) :376-9

Percutaneous phenol neurolysis of the lumbar sympathetic chain with computed tomography control.

Dondelinger R, Kurdziel JC


 

J Mal Vasc 1989 ;14(4) :327-33

[Lumbar sympathectomy in the aged subject : surgery or phenolization ?
Prospective study of early results].

[Article in French]

Becquemin JP, Kassab M, Bellouard A, Brugiere P, Melliere D

Service de chirurgie vasculaire, Hopital Henri-Mondor, Creteil.

Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia.  Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization ; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.


 

Anesthesiology 1991 Mar ;74(3) :459-63

Percutaneous lumbar sympathectomy : a comparison of radiofrequency denervation versus phenol neurolysis.

Haynsworth RF Jr, Noe CE

Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas.

A new percutaneous approach to sympathectomy using radiofrequency denervation has seemed to offer longer duration and less incidence of postsympathetic neuralgia as compared to phenol sympathetic blocks. To compare these techniques, 17 patients underwent either phenol lumbar sympathetic blocks (n = 9) or radiofrequency denervation (n = 8). Duration of sympathetic block was followed by a sweat test and temperature measurements. Results indicate that 89% of patients in the phenol group showed signs of sympathetic blockade after 8 weeks, as compared to 12% in the radiofrequency group (P less than 0.05). Although the incidence of post sympathetic neuralgia appears to be less with radiofrequency denervation, further refinement of needle placement to ensure complete lesioning of the sympathetic chain will be required before the technique can offer advantages over current phenol techniques.
 


 

Int Angiol 1986 Apr-Jun ;5(2) :83-6

Percutaneous chemical lumbar sympathectomy with alcohol with computed tomography control.

Zagzag D, Fields S, Romanoff H, Shifrin E, Cohen R, Beer G, Magora F

Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy.
 


 

Agressologie 1990 Apr ;31(4) :210-1

[Thoracic sympathectomy by phenol injection under x-ray computed tomography.
Two initial results].

[Article in French]

Fondras JC, Dreyfus A, Loubrieu G, Ntarundenga U

Service de chirurgie vasculaire, Centre hospitalier general, Bourges.

Difficulties in surgical or neurolytic techniques of the sympathetic thoracic chain and the results have been controversial in the upper limbs arteriopathies. A percutaneous technique of neurolytic block under computed tomography in two patients, give evidence of efficacy on pain and skin ulcers.


 

Neurosurgery 1996 Apr ;38(4) :715-25

Percutaneous radiofrequency upper thoracic sympathectomy.

Wilkinson HA

Division of Neurological Surgery, University of Massachusetts Medical School, Worchester, USA.

Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy.  Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective.
 


 

Ann Med Interne (Paris) 1996 ;147(5) :299-303

[Percutaneous thoracic sympathectomy under x-ray computed tomographic control in hyperhidrosis and refractory ischemia. Apropos of 17 cases].

[Article in French]

Wazieres BD, Bartholomot B, Fest T, Combes J, Kastler B, Dupond JL

Service de Medecine Interne, Hopital Jean-Minjoz, Besancon.

We report our experience with percutaneous thoracic sympathectomy using computed tomography-guided injection of phenol in 17 patients. A total of 24 neurolyses were performed in outpatients. Indications were palmo-plantar hyperhidrosis in 10 patients and severe Raynaud phenomena in 7 cases (Sharp's syndrome = 2. sclerodermia = 3, Raynaud's syndrome = 1, digital arteritis = 1). Conventional treatment had failed in all patients. Cure was obtained in all cases of hyperhidrosis. For the patients with critical ischemia, there was temporary improvement which allowed wound healing, but recurrence was the rule within 6 months on average. Complications included pneumothorax, brachial nevralgia which persisted for 4 months and 3 partial Claude-Bernard-Horner syndromes. This technique is an inexpensive reliable method which can be used in case of contraindications or to avoid certain complications of endoscopic surgery which remains the standard treatment.  Percutaneous sympatholysis in thus an interesting simple alternative.
 


 

Semin Laparosc Surg 1994 Dec ;1(4) :241-253

Endoscopic Sympathectomy.

Cuschieri A

Department of Surgery, Ninewells Hospital and Medical School, Dundee,
Scotland

Denervation of the sympathetic nerve can be accomplished with much less operative trauma by using the endoscopic surgical approach. Although endoscopic thoracic sympathectomy is not new, the techniques and the extent of denervation have not been standardized. The anatomic appearances and configurations of the sympathetic chain are explained, and various procedures, including ramisections, interganglionic sympathectomy, and ganglionectomy, are reviewed. Thoracoscopic approaches, operative techniques, and potential complications are discussed.
 


 

Radiol Clin North Am 1998 May ;36(3) :509-21

Percutaneous epidural and nerve root block and percutaneous lumbar sympatholysis.

Link SC, el-Khoury GY, Guilford WB

University of Minnesota, Minneapolis, USA.

Epidural steroid injections and selective nerve root blocks currently are considered standard techniques in the diagnosis and treatment of back pain.  The targeted epidural and perineural steroid injection with nerve block is a new technique that combines an epidural steroid injection and a nerve block.  Radiologists are best suited for performing these procedures because of their training and skills in fluoroscopy and needle procedures.
 


 

J Pain Symptom Manage 1995 Feb ;10(2) :98-104

Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease.

Gleim M, Maier C, Melchert U

Clinic of Anesthesiology and Intensive Care Medicine, Christian-Albrechts University, Kiel, Germany.

Thirty patients with angiographically proven peripheral vascular disease (PVD) and intermittent claudication were treated with percutaneous lumbar neurolytic sympathetic blockade (NSB) using 1.5 mL ethanol 95%. Claudication had been progressive in all patients during conservative treatment. Median (range) painless walking distance increased from 95 (10-200) meters (m) before to 355 (25-1003) m immediately after NSB. Further improvement was seen during the 1-year follow-up, with two exceptions : one patient lost a leg after acute arterial embolism and another patient deteriorated after 6 months. In the latter case, a second NSB improved the walking distance again. One case of transient mild neuralgia of the L3 dermatome occurred.  31P-magnetic resonance investigations of the calf muscles before, during, and after a treadmill exercise were performed in seven patients : 1 week after NSB, the postexercise recovery of phosphocreatine was accelerated in all patients compared to the pre-NSB values. The accelerated recovery suggests an improved post-ischemic metabolic situation after chemical sympathectomy.