I. Tarfusser.
6th International Symposium on Sympathetic Surgery (ISSS) 4th-6th May 2005 University Campus Vienna Austria
Clinical Autonomic Research, Volume 15, Number 2 / April, 2005 (abstract)
The reported results of T4-operations for the treatment of palmar hyperhidrosis (PHH) vary significantly between different surgeons. The suspicion arose that, depending of the technique used, declared T4 procedures might involve higher structures of the sympathetic trunk, thus impacting the result. The aim of this study was to clarify the relationship between the T3 ganglion and the ribs and its possible implications in surgery.
Materials and methods: 121 patients (51 F, 70 M) with PHH underwent ETS/ESBC between Jan 2003 and July 2004. The location of the T3 ganglion in relation to the ribs was studied by careful dissection of the sympathetic trunk from T2 to T4, including the rami communicantes.
Results: In only 28% (right) and 42% (left), the T3 ganglion was found to be freely located above the 4th rib. In 27% and 25%, respectively, the rostral end of the ganglion was located below the upper edge of the 4th rib. Asymmetry between left and right was frequently observed, with a predominance for a lower location of the right T3 in 45% of cases (inverse situation in 25%, symmetry in 30%). Asymmetry appeared to be more pronounced in women than in men.
Conclusions: In contrast to the T2 ganglion, the location of the T3 ganglion is more variable and, more often than not, close to or on the 4th rib, in some cases even below. This might explain the discrepancy of results of "T4 operations": using the 4th rib as a landmark to interrupt the trunk delivers better results than dissecting and destroying ganglion T4. It seems likely that many "T4 procedures" are actually successful because of the interruption encompassing T3 and/or the interganglionic segment T2-3. The nomenclature of ET sympathetic surgery appears to be in dire need of revision to make results comparable.
Slides: