CT-Guided, Percutaneous Ethanol Sympatholysis for Primary Hyperhidrosis

Purpose: Primary hyperhidrosis (PH) typically involves the craniofacial (CF) or axillary-palmar (AP) region. Our purpose was to determine the safety and efficacy of CT-guided sympatholysis for treating PH. Methods: In this prospective study, 39 consecutive patients with CF or AP PH were referred for percutaneous sympatholysis. Procedures were performed under CT guidance and minimal sedation. We treated level T2 for CF hyperhidrosis and T2, T3, and T4 for AP hyperhidrosis. Twenty-two-gauge spinal needles were placed bilaterally at the anterolateral surface of the vertebral body. After infiltration of lidocaine (2 mL), a neurological test was performed to exclude Horner syndrome. Neurolysis was effected with ethanol (2 mL) via each needle. Patients were discharged 1 h postoperatively and followed up at 1 week, 1 month, and then as clinically indicated. Disease-free Kaplan–Meier curves were compared using log-rank tests. Complications were categorized according to Common Terminology Criteria for Adverse Events. Results: One patient failed the lidocaine test and was excluded. Of the 38 patients included in this cohort (16 men), mean age was 38 years (range 18–61), and mean follow-up was 18 months (range 1–36). Technical success for these 38 patients was 100%. Seventeen patients had symptom recurrence, 14 of whom were retreated. Efficacy was 72% for CF hyperhidrosis, 50% for AP hyperhidrosis, and 60% overall. There were three major complications (two pneumothoraces, one severe intercostal neuralgia requiring medication). Conclusions: CT-guided sympatholysis for CF or AP PH had 18-month efficacy rates of 72 and 50%, with a favorable risk profile. Level of Evidence: Level 2b.