Surgery of the Sympathetic Nervous System for Hyperhidrosis and Facial Blushing

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Hyperhidrosis and Facial Blushing


- Hyperreactivity of the Sympathetic Nervous System -

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Surgery of the sympathetic nervous system


Surgical interventions on the peripheric sympathetic nervous system are usually performed on the sympathetic trunk, only exceptionally further peripherally on the network of tiny fibers surrounding the vessels. In the last decades, traumatic open surgery has been replaced by minimally invasive (endoscopic) techniques.

  • Interruption of the nerve:
    By far the most common procedures on the sympathetic nervous system aim at interrupting the nervous fibers in order to prevent excessive nervous impulses from reaching the target area. The effect is immediate and the success rate is very high, provided the operation has been performed correctly.
    Principally, the nerve can be
    • severed (cut)
    • heat coagulated
    • compressed (with clips providing pressure that blocks conductivity of the nerve (clamping, ESB - endoscopic sympathetic block)
    Depending from the type and location of hyperhidrosis, the sympathetic chain can be interrupted:
  • Restoring nerve function:
    In case of severe side effects, it may be necessary undo the interruption. Basically, the chances of recovery diminish with increasing degree of destruction of the sympathetic chain and increasing duration of the interval. In contrast to the interruption of the nerve, the result will appear very slowly, if at all.
    • Reversion of the blockade: removal of the inserted clips at ESB.
    • Reconstruction: in exceptional cases with extreme side effects, reconstruction of the sympathetic chain could be attempted by bridging the defect with a short segment of another nerve (nerve graft). However, to have a minimal chance of acceptable improvement after grafting, the degree of destruction of the sympathetic chain, caused at the original surgery, should not be too extensive.


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