Hyperhidrosis, a condition which causes excessive, unpredictable sweating, is now curable using endoscopic sympathectomy. This minimally invasive procedure offers a dramatically shorter recovery time than traditional thoracic sympathectomy, which requires months of rehabilitation. Endoscopic sympathectomy can be performed on an outpatient basis, and patients can usually resume normal activity in about a week. The procedure has been performed in Charlotte by the neurosurgeons of Carolina Neurosurgery & Spine Associates
What Is Hyperhidrosis?
There are five million sweat glands throughout the body. Two thirds of these glands are actually located in the hands. Sweating is a natural body function controlled by the sympathetic nervous system, and is necessary for the regulation of body temperature. Yet in some people (1% of the population), these nerves are over-stimulated and an excessive amount of sweat is produced. This condition, known as hyperhydrosis, usually starts during adolescence and is lifelong. The profuse sweating of the hands, feet and armpits associated with hyperhydrosis can be episodic or continuous, and may be caused by warm weather, emotional stress, nervousness or occur without any reason.
Forms of Hyperhidrosis
Facial Hyperhidrosis: Facial sweat may cause the patient to appear overly nervous when this is not the case. Some patients may also experience excessive facial blushing.
Palmer Hyperhidrosis: The amount of hand sweating varies from patient to patient and can range from mere moisture to dripping perspiration. Many patients report that their hands also feel cold. Sweaty hands make sufferers feel very uncomfortable in business and social situations and are often the most distressing manifestation of hyperhydrosis.
Axillary, Plantar, And Other Symptoms Of Hyperhidrosis
Axillary hyperhidrosis refers to excessive sweating in the armpits resulting in embarrassing wet marks on shirts and increase body odor. Extreme sweating of the feet is known as Plantar hyperhidrosis and is a known cause of foot odor. Less commonly, patients may experience increased sweating of the trunk or thighs.
A Minimally Invasive Solution
Sympathectomy is a surgical procedure in which the nerves that transmit signals to the sweat glands are cut. These nerves that trigger sweating in the hands, face, and feet are located in the chest cavity. In the past, an open chest procedure, which involved an extended recovery, was required to access and cut these nerves. Many patients preferred to just live with their symptoms because of the magnitude of surgery required to treat the condition.
New advances in minimally invasive surgery now permit our neurosurgeons to perform this procedure on an outpatient basis. Small endoscopes similar to those used in arthroscopic knee surgery, are inserted into the chest through three, one-half inch incisions under the armpit. This procedure is termed endoscopic thoracic sympathectomy.
With this process, the neurosurgeon cuts the sympathetic nerves of the T-2 ganglion with magnification and illumination provided by a miniature fiber optic camera. The surgery takes only an hour and most patients return to work and regular physical activity within one week. The endoscopic technique is very safe and is curative in 98% of patients. Traditional thoracic sympathectomy requires months of recovery for the patient.
Non-surgical Treatment
Conservative, non-surgical treatment is often suggested and recommended before considering surgical intervention for hyperhidrosis. Non-surgical treatment options include:
Antiperspirants
This is the simplest of all treatment options and works for patients with light to moderate hyperhidrosis. The most effective antiperspirant agent is aluminum chloride.
Iontophoresis
If antiperspirants fail, Iontophoresis is sometimes recommended. This treatment consists of applying low-intensity electric current to the hands or feet immersed in an electrolyte solution. Patients must repeat this procedure regularly several times a week. The results vary, and many patients believe Iontophoresis is too time consuming and expensive. It is difficult or impossible to treat axillary or facial hyperhidrosis with this method.
Anticholinergic Drugs
Various drugs may reduce sweating. But because of side effects that include dry mouth, blurred vision and sedation, most patients prefer not to use these medications to treat their hyperhidrosis.
Botulinum Toxin Injections
Botulinum toxin is a poison that interferes with nerve conduction and is often used in low doses to prevent wrinkles by paralyzing muscles in the face or neck. It may also be used to treat hyperhidrosis by paralyzing the sympathetic nerves that cause sweating by injecting the toxin in the axilla or hands. Botulinum toxin is often beneficial for axillary and palmar hyperhydrosis. However, the treatment is temporary and has to be repeated two or more times a year. Over time, some patients feel Botulinum toxin injections are too expensive.